T.D.B. vs. 1020 ENG reimbursement percentage andtheinsured amountcontracted. policy. The amountto bereimbursed willnever exceed thefollowing maximumlimitsfor eachoftheservices, andwillbecalculated according to the Outside theCignaDentalNetwork, theinsured willbereimbursed according to theplancontracted, asindicated intheparticularconditions ofthe PLANS: MAXIMUM REIMBURSEMENTFORDENTAL SERVICES 2021 DENTAL AESTHETICS * Doesnotincludethecleaningofremovable prosthesis orimplants 1.- PREVENTIVEANDCOSMETIC IMPLANT STUDY &MAINTENANCE AESTHETIC SMILEDESIGN COMPLEMENTARY EXAMINATIONS RADIOGRAPHS 0.- ORALDIAGNOSIS 0750 0220 0720 0460 0450 0700 0440 0430 0250 0420 0224 0550 0530 0222 0520 0140 0410 0190 0150 0310 0130 0120 0210 0710 1540 0415 0314 0214 1550 1530 1520 0312 B ZONE 0212 0510 1535 0110 1410 1140 1150 1310 1510 1130 1210 1120 1515 1110 1115 1117 1111 Desensitising sealing(hypersensitivity treatment) Sealing ofpitsandfissures (permanentmolars) Topical application offluoride, persession (twice a year) Staining andplaqueindex E. max®pressed porcelain Diet planfor decay control Training onOral brushingtechnique CT scan/Dentascan(bothjaws) CT scan/Dentascan(one jaw) CT scan/Dentascan(sector) Aesthetic lithiumdisilicate veneer Porcelain veneer Training onOral hygiene Use ofbicarbonate (difficult stains) (fluoridepaste) Second Periodontal Scalingandsuccessive (oral cleaning) Biomodel Mock up/ModelAesthetic test (perpiece) Blood collection for distinct profiles Microbiological test /biochemicalstudies (sampling) Biopsy (sampling) Orthopantomography Bitewing X-Rays Occlusal X-Rays Periodontal X-RaysPeriodontal X-Rays ofthetempomandibular joint Lateral X-Rays (Teleradiography) Only at authorized network clinics(Tel. 902 040344) Nocturnal, weekend andholiday emergencies. Checkup Professional assessment Emergency examination (during consultation hours) Quote Initial oral examination anddiagnosis Composite veneer Whitening ofnonvitaltooth (persession) Plasma orlaserlightwhitening (perarch) Whitening ofvitalteeth (perarch) Prophylaxis (annualteeth cleaning) or videos) Study and planningfor digitalrecreation (includesphotographs and/ Data intake withintraoral scanner Cephalometrics Diagnostic photography Periapical X-Rays Basic periodicmaintenance photography andradiological-surgical splint Clinical examination, orthopantomography withmarkers, models, Waxing diagnosis(pertooth) Study models Planning 3Dmodelswithoutsurgical splints(scanner notincluded) polishing ofprostheses, radiographs andretraining onoral hygiene Full annualmaintenance: bougienage, prophylaxis, disassembly and CIGNA SALUD DENTAL MIXTO Aragón, Cataluña, IslasBaleares, LaRioja,Madrid,Navarra yPaís Vasco Customer Service 91418 40-93 301 06 56|www.cigna.es €403 €240 €290 €426 €425 €100 €104 €190 €150 €108 €155 €115 €40 €40 €40 €40 €40 €40 €60 €50 €50 €50 €20 €46 €30 €30 €30 €30 € 24 € €55 €85 €58 €58 €28 € 27 € €10 €10 €10 €10 €10 €10 €10 €81 €15 €21 €17 €12 €13 €12 2.- PERIORAL AESTHETICS PULPECTOMY: (including 3500 andnecessary X-rays) 3.- SPACE MAINTAINERS PEDIATRIC INLAYS 2450 2450 2440 2430 2430 2240 2420 2420 2434 2434 3305 2550 2230 2205 2436 2436 2520 2220 2432 2432 2225 1640 2410 2140 2410 1560 1630 2190 2160 1620 2414 2150 2105 2510 2130 2310 2210 2120 2145 2412 2412 2147 1635 2165 1625 2155 2152 1610 2110

Gingival surgery (pertooth) Recement inlay Composite inlay Gingival surgery (pertooth) incisionanddrainagePulp (emergency treatment) Extraction, deciduoustooth incisionanddrainagePulp (emergency treatment) Extra for laserdecay treatment Amalgam polishing uglyirregularities (incisorremodelling, etc.) Direct preprosthetic post impression Fitting ofintraradicular post orcast post andcore Fitting pins Direct pulpcapping Major restoration withfiberorcarbonpost Porcelain inlay CAD/CAM inlay Noble metalinlay Indirect pulpcapping Pulpotomy Root-end barrierformation (pervisit) Indirect pulpcapping Pulpotomy Root-end barrierformation (per visit) Complex amalgam(reconstruction) Amalgam (2surfaces) Major restoration withdowels and/or pins(cores) Hyaluronic acidfilling for nasolabialfurrows (persession) Hyaluronic acidfilling for lips(pervial) Hyaluronic acidfilling for marionette lines(persession) Hyaluronic acidfilling for nasogenianfurrows (persession) Facial mesotherapy (persession) Lumineers®daVinci® ultra-slim veneer (notcarved) Supplement for mechanized root canals withrotary instruments Metal inlay (per session) Hyaluronic acidfilling for nasogenianfurrows +marionette lines+lip Stainless steel preformed crown Restoration Amalgam (filling) Amalgam (filling) Restoration Stainless steel preformed crown Temporary fillingindeciduous teeth Sealing ofpitsandfissures (permanentmolars) Amalgam (1surface) Provisional obturation /Filling Recementing Removable, acrylic Fixed, unilateral type (children upto age14included)Permanent dentition (children upto age14included) Deciduousdentition €449 € 330 €330 € 426 €426 € 368 €368 € 322 €322 €322 €322 € 140 €140 € 134 €134 € 186 €186 € 125 €125 € 138 €138 €175 € 40 €40 € 40 €40 € 60 €60 € 50 €50 € 50 €50 € 50 €50 € 30 €30 € 94 €94 € 46 €46 € 34 €34 € 43 €43 € 43 €43 € 24 24 € € 24 24 € € 68 €68 € 62 €62 € 88 €88 € 25 €25 € 25 €25 € 25 €25 € 35 35 € € 32 €32 € 53 53 € € 27 27 € € 37 37 € € 40 € 40 € 41 41 € € 19 €19 € 15 €15 € 81 €81 € 12 €12 €12 € 7 €7 €7 € 7 €7 €7 T.D.B. vs. 1020 ENG FIXED PROTHESIS 5.- REGENERATIVE THERAPY -BONEGRAFTING 4.- PERIODONTICS ENDODONTRIC SURGERY 4290 3440 4550 4450 4850 4430 4350 4520 4330 4420 4820 4320 4035 4230 4590 4220 3420 4740 5050 5040 3500 4030 5030 4770 5020 4020 3306 3350 5025 3330 3320 4825 4010 4410 3335 3325 5010 4510 4810 4310 5140 4130 4210 3410 4120 4710 5160 5180 5150 5130 5120 3310 5170 5145 4132 5147 3315 4110 5110 Laser treatment (persession) Peridontogram Periodontal splinting(sector) Periodontal splintingperpiece Free mucosal orconnective graft Flap surgery withgraft (perquadrant) Periodontal flapsurgery (perquadrant) Periodontal flapsurgery (persextant) Flap surgery withgraft (persextant) Flap surgery withgraft (perpiece) Modified Widman flap procedure (perquadrant) Periodontal surgery (surgical curettage perpiece) Clinical crown extension (hard tissue) Gingivectomy orgingivoplasty (perquadrant) Gingivectomy orgingivoplasty (persextant) Gingivectomy orgingivoplasty (pertooth) Treatment ofperiodontalpockets with Ligosan®doxycycline gel Metal/porcelain crown orbridge Metal/resin crown orbridge Metal crown orbridge Root amputation (hemisection) glycerin orozone Decontamination ofperiodontalpockets and/orperiimplantitisusing Periodontal treatment maintenance (throughout themouth) incisionanddrainagePulp (Emergency treatment) Condensed porcelain jacket (In-Ceram type) Cast orinjected porcelain jacket (Empress type) Partial crown Crown orBridgeUnit(CAD /CAM)Disilicate, E-Max®orPEEK Procera Allceram jacket orLithiumdisilicate Apex-formation withMTA (1session) Retro filling(for root) Scaling androot planing(perquadrant) Local chemotherapy application Occlusal adjustment by balancing/selective grinding Occlusal examination Autologous bonegraft (chin, tuberosity...) Retention pinorscrew (each) Jaw remodelling withbonefilling Alveoloplasty orbonefilling(biomaterials) Plasma richingrowth factors (P.R.G.F.) Titanium mesh Special modelcasting Dentoalveolar impression andmodelpositives Exploration andevaluation for prosthetic rehabilitation Regenerative Membrane Supplement for root canalsperformed undermicroscope Acrylic orComposite Jacket Temporary Resin Crown Relining orprovisional conditioner, removable Occlusal Adjustments to fitted prostheses Obtaining intermaxillary records Retreatment 3canals(X-rays included) Retreatment 2canals(X-rays included) Retreatment 1canal(X-rays included) Root canal(3 ormore canals) (X-rays included) Root canal(2 canals) (X-rays included) Root canal(1 canal) (X-rays included) Periodontal evaluation (sounding) Periapical surgery () Customer Service 91418 40-93 301 06 56|www.cigna.es € €1,067 € 200 €200 € 480 €480 € 260 €260 € 350 €350 € 520 €520 € 432 €432 € 243 €243 € 265 €265 € 255 €255 €263 € 283 €283 €283 € 104 €104 € 150 €150 € 164 €164 € 148 €148 € 189 €189 € 162 €162 € 216 €216 € 155 €155 € 188 €188 € 155 €155 € 177 €177 € 135 €135 € 152 €152 € 110 €110 € 119 €119 € 131 €131 € 113 €113 € 131 €131 € 40 €40 € 60 €60 € 44 €44 € 50 €50 € 20 €20 € 30 €30 € 70 70 € € 66 €66 € 54 €54 € 34 €34 € 39 39 € € 97 97 € € 83 €83 € 58 €58 € 55 €55 € 22 €22 € 28 €28 € 35 35 € € 35 35 € € 32 €32 € 31 €31 € 12 €12 € 12 €12 €12 €12 € 12 €12 €12 € 27 27 € REMOVABLE PROSTHESIS 6.- OCCLUSION /TMJ REPAIR PROCEDURES IMPLANT PROSTHETICS COMPOSITE PROSTHESES 5960 5840 5540 5420 5860 5740 5950 5560 5930 5905 5630 5920 5850 5830 5820 5330 5546 5520 5634 5570 5230 5924 5730 5940 5720 5854 5636 5542 5865 5955 5565 5529 5632 5858 5922 5853 5852 5528 5335 5525 5522 5410 5910 6130 6120 5810 5510 5310 5210 5710 5415 5816 5815 5185 5817 5715 6110 Rebase enel1erañodeunaprótesis removible nueva Soft resin rebase Common rebase Temporary tissue adaptation (old prosthetic) Rebasing specialmaterials Tooth retention system replacement (teflon, retainer…) Hybrid prosthesis screwed onto implants(porcelain teeth) Hybrid prosthesis screwed onto implants(resin teeth) Mucosa-implant supported overdenture (withriders) retainers /hooks…) Skeletal partialdentures (10ormore teeth) (itincludesbraces, plates, retainers /hooks…) Skeletal partialdentures (7to 9teeth) (itincludesbraces, plates, retainers /hooks…) Skeletal partialdentures (4to 6teeth) (itincludesbraces, plates, retainers /hooks…) Skeletal partialdentures (1to 3teeth) (itincludesbraces, plates, Prosthesis Restoration oradditionofdentalpieces offlexible Removable Partial Neobase to rebase more than5dentalpieces Aesthetic clasp Porcelain fixture Mechanical bridgedismantling LOCATOR® typeanchor Zirconium abutment Recement crowns Provisional crown onimplant Cast noblemetal stump Cast metalstump, more thanoneroot Two barson4ormore implants Bar on3ormore implants Bar on2implants Ball attachment (0-Ring,Dal-Ro, amongothers) Dental crown orbridgeunitinzirconia (CAD/CAM) Noble metal/titaniumcrown orbridge Neobase to rebase upto 5dentalpieces Parcial flexible (Valplast orFlexite...) (7ormore teeth) Parcial flexible (Valplast orFlexite...) (4 to 6 teeth) Partial flexible (Valplast orFlexite...) (1 to 3 teeth) Hard discharge splint(Michigankind) Selective grinding Angle orcosmetic abutment Transepithelial abutment Supplement for porcelain teeth (pertooth) Supplement for hypoallergenic orappropriate resin Partial acrylic (7ormore teeth) Partial acrylic (4to 6teeth) Partial acrylic (1to 3teeth) Complete acrylic(upperorlower) Maryland Bridge Noble metal/titanium crown orbridge Occlusal analysis andmountinginarticulator Replace pieces orretainer orsupport Simple resin repair Removable denture cleaning Bridge supportoronlay Cast metalstump, oneroot Complex precision attachment Simple precision attachment Telescopic crown Retention magnets Retention bar €2,630 €2,362 € 400 €400 € 600 €600 € 460 €460 € 406 €406 € 540 €540 €480 € 494 €494 €894 €230 €498 €740 € 370 370 € 370 € € 245 €245 €766 €243 € 329 €329 €638 €255 € 533 €533 €140 €170 € 184 €184 € 148 €148 €421 € 216 €216 €192 €192 €281 € 182 €182 € 128 €128 € 127 €127 €175 €110 € 113 €113 €80 € 50 €50 €66 € 96 €96 €48 €48 €56 € 98 €98 € 89 89 € € 67 67 € €88 €32 €38 € 52 € € 87 € € 27 27 € € 27 27 € € 57 € € 74 € € 18 €18 T.D.B. vs. 1020 ENG 8.- IMPLANTOLOGY 7.- ORALSURGERY 6600 8340 8390 7430 7340 7420 7900 8290 8260 7890 7860 8400 8200 7590 7360 8350 8280 8330 6200 8250 8320 7850 7350 7330 7250 7320 7730 7720 7220 7865 8282 7855 8332 7852 8100 8010 6140 7410 8106 6510 8310 8105 8103 8210 7810 6134 7310 7210 7120 6135 6132 8281 7125 8101 8110 7110 8111 Surgical extraction ofimplant Peri-implant surgery Autologous bonegraft (chin, tuberosity, etc.) Bone filling(biomaterials) Non-resorbable membrane Resorbable membrane Maxillary sinuselevation (only surgery) Pre-implant surgery Complicated suture or>5cm.(non-dentaltreatment) Recent wound suture <5cm.(non-dentaltreatment) Preprosthetic surgery Stitch removal Crown exposure for orthodontictraction Laser treatment (persession) Conditioning of removable prosthetic tissues Ostectomry (removal ofexostosis, torus, etc.) Sedation withnitrous oxide Sialolithotomy Removal ofsubmucosal foreign body Postoperative monitoring Tooth extraction andreimplantation Re-implant, stabilisation oftooth subluxation oravulsion Fenestration to uncover implant Implant replica Healing post Closure screw / cap Microimplant for orthodontictraction Immediate provisional implants(IPIs) Special implants(wideplatform, immediate loading...) Osseointegrated endosseous implant Surgical crown lengthening Minor surgery (soft tissue, epuli,fibroma...) Oroantral fistula orsinusperforation Surgical splintfor guidedsurgery (6ormore implants) Cystectomy withorwithouttooth extraction Frenectomy Splints pilotdrillguide(guidance marker) Positioning splint Diagnostic orradiological prosthesis for 2ormore implants Surgical splintfor guidedsurgery (withtitaniumcylinders) Splints pilotdrillguide(4ormore implants) Conductive alveolotomy (unerupted tooth exposure) Incision anddrainage ofperiodontalabscesses osteotomy) Extraction, impacted tooth inbonetissue (withtooth divisionand/or Wisdom tooth surgical extraction semiincluded Complex root extraction Complicated extraction and/orsuture Diagnostic orradiological splints Dental implantexamination Simple tooth extraction TemporoMandibular JointPhysiotherapy (per session) apnea (SAHOS) Intraoral anti-snoringappliances (roncopathy) /obstructive sleep IMuscle orTMJjointinfiltration Periodontal splinting Checkup, adjustment orgrindingofsplint Soft relaxation plate orwhitening tray Semi-rigid splintormouthguard Customer Service 91418 40-93 301 06 56|www.cigna.es

€1,000 €900 €900 €240 €250 €250 €780 € 270 € €565 €100 €225 €325 €190 €160 €150 €120 €120 €130 €120 €148 €168 € 630 € 630 €165 €135 €313 €110 €141 €118 €113 €40 €40 €60 €80 €50 €30 €30 €30 €45 €86 €36 € 63 € €25 €25 €25 € 35 € € 35 € €25 €28 € 35 € € 35 € € 52 € € 52 € € 75 € €15 €12 €17 € 25 9.- be carriedout(revisions are cost free). * Monthlyfees are deferred payments for treatment andtherefore, notrelated to thenumberofrevisions to 9420 9340 9402 9400 9240 9500 9505 9520 9330 9720 9370 9320 9250 9230 9294 9220 9345 9296 9245 9242 9298 9295 9293 9292 9297 9335 9725 9375 9325 9332 9228 9235 9372 9322 9225 9232 9222 9410 9510 9710 9310 9210 9291 9715 9315 9312 9215 9212 9119 9118 9115 Orthopedic forces +removable appliance (e.g.: chincup+plate) Orthopedic forces +fixed appliance (e.g.: disjunction+ face mask) Mixed treatments: Interceptive and/or orthopedictreatments Orthodontics withinvisible braces INVISALIGN® Treatment withfixed multi-bracket apparatus Orthodontic study Orthodontics for orthognathic surgery (down payment) was performed by anotherclinic) Disassembly ofappliance andteeth polishing(only ifthetreatment Appliance repair Preparation for surgical splint:monomaxillar Replacement ofbracket (from 3rd loss) each Replacement oflost appliance Aesthetic retaining Post-treatment stability (initialretainer for onesetofteeth) monitoring ofretainer - down payment for onesetofteeth Post-treatment stability (initialretainer for bothsetsofteeth) - down payment for bothsetsofteeth Short-term preprosthetics (down payment) one setofteeth - (asthesoleappliance for thewhole treatment) down payment for - eachpositionerplusupto 3 both setsofteeth - (asthesoleappliance for thewhole treatment) down payment for With fixed appliance (eg.: Q-H,B.P., NANCE,etc.) - entrypositioner2arches Ortho Tain®-type preformed positioners Mid-treatment correction - withremovable plates (for onesetofteeth) - withremovable plates (for bothsetsofteeth) Loss ofaligner(each) Further adjustments (first isincludedintreatment) Teen® Comprehensive® (from 14alignerscombined withapt.fix) Comprehensive® (from 14aligners) Lite® (upto 14aligners) Express® (upto 7aligners) Additional appliances - withaesthetic brackets (down payment for bothsetsofteeth) set ofteeth) - Self-ligating system (DAMON, etc.) (down payment for one sets ofteeth) - Self-ligating system (DAMON, etc.) (down payment for both - LINGUAL technique (down payment for onesetofteeth) - LINGUAL technique (down payment for bothsetsofteeth) Treatment supplementfor sapphire brackets (perarch) - withaesthetic brackets (down payment for onesetofteeth) - withmetalbrackets (down payment for onesetofteeth) - withmetalbrackets (down payment for bothsetsofteeth) Online Only includingtreatment plan Includes cephalometry, photos andtreatment plan

monthly payment (inbothcases)* monthly (18months)* bimaxillar monthly fee* monthly fee* monthly fee* monthly fee* monthly fee* monthly fee* monthly fee* monthly fee*

€4,900 €4,900 €4,300 €5,500 €2,500 €1,441 €1,012 €440 €200 €480 €450 €990 €660 €420 €494 €680 €560 €546 €462 €330 €845 €245 €867 € 247 € €225 € 759 € €338 €1211 € 275 € €169 €165 €195 €156 €351 €315 €65 € 39 € € 39 € €65 € 39 € €65 € 39 € €58 € 78 € €32 € 52 € € 78 € € 78 € € 78 € € 78 € €11