anesthesia with covered service, simple or surgical extraction up to  
unlimited per year. 
•$3000 maximum benefit coverage amount per year for preventive  
and comprehensive benefits. 
Dental services are subject to our standard claims review procedures  
which could include dental history to approve coverage. Dental benefits  
under this plan may not cover all American Dental Association  
procedure codes. Information regarding each plan is available at  
Humana.com/sb .