Dental Plans

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• One complete initial oral exam, including initial dental history, and charting your teeth and supporting structures (gums, bones) to evaluate their condition
• Full mouth X-rays (seven or more films), or panoramic X-ray with bitewing X-rays, once every 60 months
• Additional bitewing X-rays once every six months
• Periodic or routine oral exams 3 times per 12 months
• Emergency exams Single tooth X-rays as needed
• Study models and casts used in planning treatment once every 60 months.

Preventive Services—no waiting period

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• Routine cleaning, scaling, and polishing of the teeth 3 times per 12 months
• No waiting period for routine preventive services

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• Silver and white fillings for each tooth surface in each 12 months
• Tooth extractions and biopsies
• Periodontal scaling and root planning, once in each quadrant each 24 months
• Periodontal surgery, once in each quadrant each 36 months
• Periodontal maintenance, once each three months
• Root Canals
• Repairs of partial or complete dentures, crowns and bridges, once each 12 months
• Rebase or reline of dentures, once each 36 months
• Recementing of crowns, inlays, onlays and fixed bridgework, once each 12 months
• Bite adjustment, once each 24 months
• Services to treat root sensitivity
• General anesthesia when administered in conjunction with covered surgical services
• Emergency dental treatment to relieve acute pain

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• Complete or partial denture, including services to fabricate, measure, fit and adjust, once each 60 months for each arch
• Fixed bridges, including services to fabricate, measure, fit and adjust, once each 60 months per tooth
• Replacement of dentures and bridges, but only when they are installed at least 60 months after the initial placement, and only if the existing appliance cannot be made serviceable
• Adding teeth to an existing bridge
• Temporary partial dentures to replace any of the six upper or lower front teeth, but only if they are installed immediately following the loss of teeth and during the period of healing
• Metallic, porcelain, and white resin inlays, once every 60 months per tooth
• Replacement of crowns and metallic, porcelain and composite resin inlays/onlays once every 60 months for each tooth
• Post and core or crown build up once every 60 months per tooth
• Surgical placement of dental implant once per tooth per lifetime