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4.2 DIAGNOSTIC AND PREVENTIVE BENEFITS. Delta Dental agrees to pay 100% of the Dentist's Usual, Customary and Reasonable fees or the Fee Actually Charged, whichever is less, or 100% of the Delta Dental PPO Dentist's Fee for the following Diagnostic and Preventive Benefits: Diagnostic- oral examinations (including Initial examinations, periodic examinations and emergency examinations) x-rays examination of blopsled tissue palliative (emergency) treatment of dental pain specialist consultation Preventive- prophylaxis (cleaning) topical application of fluoride solution space maintainers Note on additional Benefits during pregnancy - When an Enrollee is pregnant, Delta Dental will pay for additional services to help Improve the oral health of the Enrollee during the pregnancy. The additional services each calendar year while the Enrollee Is covered under this Contract Include: one additional oral exam and either one additional routine cleaning or one additional periodontal scaling and root planing per quadrant. Written confirmation of the pregnancy must be provided by the Enrollee or her dentist when the claim Is submitted. 4.3 BASIC BENEFITS, Delta Dental agrees to pay 75% of the Dentist's Usual, Customary and Reasonable fees or the Fee Actually Charged, whichever Is less, or 80% of the Delta Dental PPO Dentist's Fees for the following Basic Benefits: Oral Surgery- extractions and certain other surgical procedures, including pre- and post- operative care Restorative- amalgam, silicate or composite (resin) restorations (fillings) for treatment of carious lesions (visible destruction of hard tooth structure resulting from the process of dental decay) Endodontic- treatment of the tooth pulp Periodontic- treatment of gums and bones supporting teeth Sealants- topically -applied acrylic, plastic or composite material used to seal developmental grooves and pits in teeth for the purpose of preventing dental decay Adjunctive General Services- general anesthesia; I.V, sedation; office visit for observation; office visit after regularly scheduled hours; therapeutic drug injection; treatment of post- surgical complications (unusual circumstances); occlusal adjustment, limited 4.4 CROWNS, INLAYS, ONLAYS AND CAST RESTORATIONS BENEFITS. Delta Dental agrees to pay 50% of the Dentist's Usual, Customary and Reasonable fees or the Fee Actually Charged, whichever is less, or 50% of the Delta Dental PPO Dentist's Fee for the treatment of carious lesions (visible destruction of hard tooth structure resulting from the process of dental decay) which cannot be restored with amalgam, silicate or direct composite (resin) restorations. ' 25C-59