Benefits are payable when using one of the Preferred Providers. If you choose another provider that
does not participate with DINa Dental, you may incur additional charges. The scheduled Charge is
the maximum amount which benefits will be paid, if you see a non-participating provider they may
charge more than the scheduled charge. If your dentist charges more than the scheduled charge, you
will pay the deductible and co-insurance plus the amount over the Scheduled Charge.