BENEFITS SCHEDULE. a. The plan shall provide for the payment of one hundred percent (100%) of the usual, customary, and reasonable charges for preventative and diagnostic services such as: 1) Routine oral examinations twice every twelve (12) months unless medically necessary; 2) Teeth cleaning twice every twelve (12) months; 3) Fluoride treatments and dental sealants twice every twelve (12) months; 4) Emergency treatments; space maintainers; diagnostic x- rays, tests, and laboratory examinations. b. The plan shall provide for the payment of eighty-five percent (85%) of the usual, customary, and reasonable charges for basic restorative services such as: 1) Fillings (amalgams, silicate or acrylic); 2) Root canal therapy; 3) Treatment of gum disease; 4) repair of bridgework and dentures; 5) extractions and oral surgery; and
Appears in 4 contracts
Samples: Master Agreement, Master Agreement, Master Agreement
