Base Plan Buy-Up Plan Deductible $0 / $0 $0/$0 (Single/Family) Annual Maximum $0 (Per Person) $0 $0 Dental Maximum Rollover $0 Preventive Services Covered 100%, no deductible Covered 100%, no deductible Exams, Cleanings, Fluoride, X-Rays Basic Dental Services 60% after deductible is satisfied 70% after deductible is satisfied Fillings, Extractions, Endodontics, Crown Repairs Major Dental Services 20% after deductible is satisfied 30% after deductible is satisfied Crowns, Dentures, In/Outlays, Periodontics Covered 40% with lifetime max of $0 Orthodontia Services Not covered per person; this service is not subject to the deductible Rollover provisions apply. Please see your certificate of coverage.