adjustment up to 1every 3  
years. 
•50% of the cost for bridges up  
to 1every 5years. 
•50% of the cost for crown, root  
canal, root canal retreatment  
up to 1per tooth per lifetime. 
•50% of the cost for oral surgery  
up to 2per year. 
•$2000 combined maximum  
benefit coverage amount per  
year for preventive and  
comprehensive benefits. •0% of the cost for necessary  
anesthesia with covered service  
up to unlimited per year. 
•$25 copay for scaling and root  
planing (deep cleaning) up to 1