Annual Plan Maximum Deductible (Single / Family) $1,000 100% Covered 70% Covered 40% Covered Not Covered $50 / $150 Preventive Services Exams, Cleanings, Fluoride, X-Rays Basic Services Fillings, Extractions, Endodontics, Crown Repairs Major Services Crowns, Dentures, In/Outlays, Periodontics Orthodontia Services D E N T A L B E N E F I T S $2,000 100% Covered 80% Covered 50% Covered 50% to $1,500/Child $50 / $150 Base Plan Buy-Up Plan