Medical Mutual

Annual Benefit Maximum                                                    Calendar Year
     - Per insured person
Annual Maximum Carryover

Orthodontic Lifetime Benefit Maximum
     - Per eligible insured person

Annual Deductible
     - Per insured person
     - Family maximum

Deductible Waived for Diagnostic/Preventive Services Yes

Dental Services

Diagnostic and Preventive Services, for example:
     - Periodic oral exam
     - Teeth cleaning (prophylaxis)
     - Bitewing X-rays:   1x per 12 months
     - Intraoral X-rays
100% of R&C
Basic Services
     Fillings, for example:
     - Amalgam (silver-colored)
     - Front composite (tooth-colored)
     - Back composite    Alternated to Amalgam Benefit
80% of R&C
Major Services
     Prosthodontics, for example:

     - Dentures
     - Bridges
     Prosthetic Repairs/Adjustments
     Endodontics, for example:
     - Root Canal
     Periodontics, for example:
     - Scaling and root planing
     Oral Surgery

80 % of R&C
Orthodontic Services

60% of R&C


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