INSURANCE CARRIER DELTA DENTAL Advantage 200 PPO Plus Premier 2500 Plan Name w/ D&P Ortho 1500 Major Services Waiting Period None Advantage PPO Non PPO Basis of Reimbursement 90th $50 $50 200 PPO Plus Annual Deductible Calendar Year Calendar Year/Policy Year Yes Waived for Preventive Premier 2500 Preventive: Oral Exams, Cleanings, Bitewing X-Rays, & Other 100% 100% Procedures Basic: Lab Test, Fillings, General Anesthesia & Other 80% 80% Procedures Major: Crowns, Bridges, Dentures, 50% 50% & Other Procedures Oral Surgery Basic Endodontics & Periodontics Basic Implants Major Fillings - Posterior Teeth (Molars) Amalgam Crowns Frequency Limitation 1 per 5 years Annual Benefit Maximum $2,500 Orthodontia Not Covered