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  
per quadrant every 3years. 
•$25 copay for scaling for  
moderate inflammation up to 1  
every 3years. 
•$25 copay for crown  
recementation, denture  
recementation up to 1every 5  
years. 
•$25 copay for emergency  
treatment for pain up to 2per  
year. 
•$25 copay per tooth for  
amalgam and/or composite