Deductible $50 per covered member Annual Plan Maximum $1,250 / person Preventive Services Exams, Flouride, Sealants, Space Maint. You Pay 0% Basic Services Fillings, Simple/Complex Extractions, Endo/Perio You Pay 20% Major Services Prosthodontics, Implants, Inlays, Onlays, Crowns You Pay 20% Orthodontia Services You Pay 40% Orthodontia Lifetime Maximum $500