Common use of Basic Dental Services Clause in Contracts

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. 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. 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. 4 Maximum Benefit Each eligible patient shall be entitled to a $1,500.00 benefit per calendar year, except that Orthodontics shall be limited to a lifetime maximum benefit of $1,000.00 per patient.

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 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% 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.