Deductible $50 / $150 (Single/Family) Annual Plan Maximum $1,000 Preventive Services 100% Covered Exams, Cleanings, Fluoride, X-Rays Basic Services 80% Covered Fillings, Extractions, Endodontics, Crown Repairs Major Services 50% Covered Crowns, Dentures, In/Outlays, Periodontics Orthodontia Services 50% Covered Orthodontia Lifetime Maximum $1,000