Base Dental High Dental Options PPO Plan PPO Plan Individual $50 $50 Family $150 $150 Annual Maximum Per covered person $1,000 $1,000 Preventative Care Oral Exams (once/6 months), Cleanings, X-Rays (full mouth Covered at 100% Covered at 100% once/60 months) Major Procedures Bridges & Dentures, ENDO (Root Canal), Single Crowns, Simple & Covered at 50% after Covered at 90% after Complex Extractions, PERIO deductible deductible Maintenance (scaling and root planing) Out-of-Network Annual Maximum $1,000 $1,000 Deductible $100 / $300 $50 / $150 9