Dental Plus has higher allowed amounts, which are the maximum amounts allowed by the Plan for a covered service. Network providers cannot charge you for the difference in their cost and the allowed amount. Your dental benefits are divided into four classes:

• Diagnostic and preventive (exams, cleanings, X-rays): You do not pay a deductible. The Plan will pay 100 percent of a higher allowed amount. In network, a provider cannot charge you for the difference in its cost and the allowed amount.
• Basic (fillings, oral surgery, root canals): You pay up to a $25 deductible per person.  The Plan will pay 80 percent of a higher allowed amount. In network, a provider cannot charge you for the difference in its cost and the allowed amount.
• Prosthodontics (crowns, bridges, dentures, implants): You pay up to a $25 deductible per person.¹ The Plan will pay 50 percent of a higher allowed amount. In network, a provider cannot charge you for the difference in its cost and the allowed amount.
• Orthodontics² (limited to covered children ages 18 and younger): You do not pay a deductible. There is a $1,000 lifetime benefit for each covered child.

The maximum yearly benefit for a person covered by Dental Plus is $2,000 for diagnostic and preventive, basic and prosthodontics services. Not all dental procedures are covered. You will be responsible for any charges related to non-covered services. More information about non-covered services is available in the Insurance Benefits Guide.

¹ If you have basic or prosthodontic services, you pay only one deductible. Deductible is limited to three per family per year.
² There is a $1,000 maximum lifetime benefit for each covered child, regardless of plan or plan year.