As Pai Gow Poker is played with a standard 52-card deck and a joker, you must be dealt all 4 aces and the joker to create this hand. The chance of this happening stands at roughly 140,000/1, which makes it an unlikely scenario but one that could still happen. Also, if this were to occur and you had placed a bonus side bet, you would be looking at an additional 400/1 payout.