Features of Each Option	Option 1	Option 2		Option 3
		In-Network	Out-of-Network
Dentists	Any dentist you choose1	Network dentist2	Any dentist you choose3	Any dentist you choose1, 3
Calendar Year Deductible	$25 per person for Type B and Type C covered services	$25 per person/$75 per family for Type B and Type C covered services	$75 per person/$150 per family for TYpe B and Type C covered services	$25 per person/$75 per family for Type B or Type C covered services
Co-Insurance/Co-Pay Type A - Preventive Benefits Oral Exams - two in a calendar year Full Mouth X-rays - One in a three-year period Cleanings - Two in a calendar year Fluoride Treatment - One treatment per calendar year Space Maintainers - Covered for children through age 19 Bitewing X-rays - Two sets in a calendar year	100% of usual and customary fees	100% of PPD fee schedule	80% of usual and customary fees	100% of usual and customary fees
Type B - Basic Benefits Periodontics Simple Extractions Endodontics Fillings TMJ occlusal guard appliance	Subject to fee schedule after deductible4	100% of PPD fee schedule after deductible	60% of usual and customary fees after deductible	100% of usual and customary fees after deductible
Type C - Major Restorative Benefits Dentures Inlays Gold fillings or crowns Bridges TMJ orthotic occlusal appliance - one appliance per lifetime	Subject to fee schedule after deductible4	50% of PPD fee schedule after deductible	40% of usual and customary fees after deductible	50% of usual and customary fees after deductible
Type D - Orthodontic Benefits (available to children through the end of the year they reach age 19)	Subject to fee schedule after $50 lifetime Type D deductible; $600 lifetime maximum	50% of PPD fee schedule; no deductible; $1,000 lifetime maximum5	40% of usual and customary fees; no deductible; $1,000 lifetime maximum5	50% of usual and customary fees; no deductible; $1,000 lifetime maximum5
Calendar Year maximum per person (excluding Type D covered services)	$600 combined for Type B and Type C covered services	$1,000 combined for Type B and Type C covered services	$1,000 combined for Type B and Type C covered services	$1,000 combined for Type B and Type C covered services
Lifetime TMJ maximum per person for all TMJ-related services	$1,0005	$1,0005	$1,0005	$1,0005

¹ There are no discounts available for using an In-network dentist in this plan since there are no Network dentists.

² Benefits paid are based on the discount fee schedule used by participating dentists.

³ Benefits paid are based on usual and customary fees.

⁴ Benefits paid are based on a very modest fee schedule.

⁵ $1,000 lifetime maximum, combined for all options, even if you change options from year to year.