Annual Plan Maximum $1,000 100% Covered 80% Covered 50% Covered Not Covered Deductible (Single / Family) $50 / $150 N/A Orthodontia Lifetime Maximum Preventive Services Exams, Cleanings, Fluoride, X-Rays Basic Services Fillings, Diagnostics Services Major Services Crowns, Extractions, Endodontics, Dentures, In/Outlays, Periodontics Orthodontia Services D E N TA L B E N E F I T S $2,000 100% Covered 80% Covered 50% Covered 50% Covered $50 / $150 $2,000 Lifetime Plan Option $1000 Plan $2000 Plan