| Dental Care | Yearly deductible | None | $50/individual;$150/family | None | $50/individual;$150/family |
| Maximum yearly benefit | $1,200 | $1,200 | $1,200 | $1,200 |
| Orthodontia maximum | $1,000 per course of treatment separated by two years | $1,000 per course of treatment separated by two years | $1,000 per course of treatment separated by two years | $1,000 per course of treatment separated by two years |
| Diagnostic and preventive services | No cost | Paid at 80% of usual and prevailing fee | No cost | Paid at 80% of usual and prevailing fee |
| Basic restorative services, endodontics, periodontics, maintenance of prosthodontics, and oral surgery | Paid at 80% of fee schedule | Paid at 80% of usual and prevailing fee | Paid at 80% of fee schedule | Paid at 80% of usual and prevailing fee |
| Major restorative services, installation of prosthodontics, and orthodontics | Paid at 50% of fee schedule | Paid at 50% of usual and prevailing fee | Paid at 50% of fee schedule | Paid at 50% of usual and prevailing fee |
