Dental Comparison Chart

	Preferred Choice		Quality Dental
	Network	Non-Network
Maximum annual benefit per person	$1,500	$1,000	$1,500
Diagnostic and preventive Oral examinations, prophylaxis (routine cleaning), bitewing x-rays	100%, two every plan year	100% R&C, two every plan year	100% R&C, two every plan year
Full mouth x-days once every 36 months	100%	100% R&C	100% R&C
Fluoride treatments Up to age 19 or age 55 and older	100%	100% R&C	100% R&C
Emergency palliative treatment (to relieve pain)	100%	100% R&C	100% R&C
Sealants for permanent molars only, once per tooth every 36 months Up to age 19	100%	100% R&C	100% R&C
	You must meet your annual deductible of $25 per person before benefits are paid for restorative, oral surgery, endodontic, periodontic and prosthetic services.		You must meet your annual deductible of $25 per person before benefits are paid for restorative, oral surgery, endodontic, periodontic and prosthetic services.
Restorative services Fillings (amalgam, acrylic and silicate cement)	100%	65% R&C	65% R&C
Oral Surgery routine extractions, surgical removal of tooth or root, removal of erupted or impacted tooth, alveolectomy	100%	65% R&C	65% R&C
Endodontics Pulp capping, pulpotomy, root canal filling or therapy, apicoectomy	100%	65% R&C	65% R&C

The network fee, a discounted fee negotiated by MetLife for service from network providers, applies to these benefits.
R&C - Reasonable and Customary: the prevailing and usual fee for services charged by dentists in your area.
Plan year - July 1 through June 30.

If you are married and your spouse has coverage through his or her employer, coordinated benefits may apply. Contact the Trust for the non-duplication coordination of benefits policy.

Percentages in the chart reflect the amount that the plan pays for your treatment or service. This chart is just a summary, and there are additional restrictions or limitations (in the plan booklets).

Updated August 2008