Basic Dental Services Clause Samples
The Basic Dental Services clause defines the range of routine dental procedures covered under a contract or insurance policy. Typically, this includes services such as cleanings, fillings, simple extractions, and diagnostic exams, which are considered essential for maintaining oral health. By clearly outlining which dental treatments are included as basic services, the clause helps prevent misunderstandings about coverage and ensures that both providers and patients know what to expect regarding benefits and potential out-of-pocket costs.
Basic Dental Services. Preventive: Prophylaxis (cleaning, scaling, and polishing, not more often than twice in a calendar year), topical application of fluoride solutions, space maintainers, oral examinations, and emergency (palliative) treatment 100% Diagnostic: X-rays, and other diagnostic procedures to evaluate the existing condition to determine the required dental treatment. Also included are Diagnostic Casts, when necessary 100% Oral Surgery: Procedures for extractions and other oral surgery, including pre- and post- operative care 80% Restorative: Provides amalgam, synthetic porcelain and plastic restorations for treatmentof carious lesions. Restorative crowns, inlays, and other cast restorations are benefits only when other materials will not satisfactorily restore the tooth 80% Endodontic: Procedures for pulpal therapy and root canal filling 80% Periodontics: Procedures for treatment of the tissues supporting the teeth 80% Prosthodontics: Procedures for construction of bridges, partial, and complete dentures 50% Orthodontics: Procedures for the correction of malposed teeth 50%
Basic Dental Services. Preventive: Prophylaxis (cleaning, scaling, and polishing, not more often than twice in a calendar year), topical application of fluoride solutions, space maintainers, oral examinations, and emergency (palliative) treatment 100% Diagnostic: X-rays, and other diagnostic procedures to evaluate the existing condition to determine the required dental treatment. Also included are Diagnostic Casts, when necessary 100% Oral Surgery: Procedures for extractions and other oral surgery, including pre- and post- operative care 80% Restorative: Provides amalgam, synthetic porcelain and plastic restorations for treatment of carious lesions. Restorative crowns, inlays, and other cast restorations are benefits only when other materials will not satisfactorily restore the tooth 80% Endodontic: Procedures for pulpal therapy and root canal filling 80% Periodontics: Procedures for treatment of the tissues supporting the teeth 80% Prosthodontics: Procedures for construction of bridges, partial, and complete dentures . . 50% Orthodontics: Procedures for the correction of malposed teeth 50% 3. Deductible A $25.00 deductible (not applicable to Diagnostic or Preventive Services) shall apply, with a maximum of $75.00 per family, per calendar year. Effective January 1, 1991 there are no deductibles.
Basic Dental Services. (1) 100% of routine treatment to a maximum of $1,500 per year/insured person.
(2) 50% of major restorative care to a maximum of $1,500 per year/insured person.
(3) 50% of orthodontic treatment to a maximum of $3,500 per insured person.
Basic Dental Services. Preventive 100%
Basic Dental Services. 9
3.2.1 Minor Treatment For Acute Dental Pain 9 3.2.2 Fillings 9 3.2.3 Extractions 9 3.2.4 Denture or Partial Repairs 10
Basic Dental Services. Charges up to the benefit maximum for: • Oral exams, including scaling and cleaning of teeth, but not more than once every 9 months; • Periodontal scaling and/or root planing (limited to 10 units per year for all procedures combined); • Topical applications of sodium or stannous fluoride but not more than one application every 9 months; • Dental x-rays, except that bite-wing x-rays are limited to one set every 6 months; • Fillings; • Extractions; • Oral surgery, including excision of impacted wisdom teeth; • Antibiotic drug injections; • Anaesthesia and its administration in connection with oral surgery or other covered dental services; • Space maintainers, including stainless steel crowns for primary teeth that have several cavities which would otherwise require fillings or which are non-restorable using normal restorative dental material; • Repair, relining or rebasing of dentures; • Repair, resurfacing or recementing of crowns, inlays, onlays or bridges; • Periodontic treatment for disease of the bone and gums of the mouth, including tissue grafts and occlusal guards, but not athletic guards; and • Endodontic treatment, including root canal therapy.
Basic Dental Services. I RECEIVE THE DENTAL PLAN?
Basic Dental Services. The following services are covered subject to the deductible, coinsurance, and maximum provisions outlined in the Schedule of Benefits: recall or specific examination, cleaning of teeth with light scaling, bitewing x-rays, topical fluoride brush-in, recall oral hygiene instruction, denture adjustments and repairs. Each service is covered twice per calendar initial examination, x-rays, panoramic x-rays, initial oral hygiene instruction, relining or of dentures. Each is covered once every months, emergency examination, sedative dressing, susceptibility and pulp tests, periapical, occlusal, intraoral, extraoral for basic procedures, passive space for missing primary teeth for children under age basic restorative fillings, including finishing, extraction of erupted or unerupted teeth including removal of residual roots, removal of lesions, tumours, cysts or abscesses, repairs of fractures and dislocations sustained from accidental injury, stainless steel or polycarbonate crowns, diagnostic laboratory procedures, anaesthesia associated with insured oral surgical procedures, excluding acupuncture, hypnosis, and dental psychotherapy, drugs administered or prescribed by the Dentist,
Basic Dental Services