Dentures. 1. Partial removable dentures, upper or lower, limited to one per 60 months 2. Complete removable dentures, upper or lower, limited to one per 60 months 3. Pre-operative radiographs required 4. Pre-treatment estimate, as described in the Estimate of Eligible Benefits section is recommended for Members 5. Tissue conditioning prior to denture impression 6. Repairs to denture as required including; repair resin denture base, repair cast framework, addition of tooth or clasp to existing partial denture, replacement of broken tooth, repairs or replacement of clasp, recement fixed partial denture D. Denture adjustments and relining limited to: Full or partial removable (upper or lower) dentures: once per 24 months, but not within six months of initial placement SAMPLE E. Repair of prosthetic appliances and removable dentures, full and/or partial. X. Xxxxxxxx guard, by report, limited to one per 12 months for Members age 13 and older
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Samples: Individual Enrollment Agreement for a Qualified Health Plan, Individual Enrollment Agreement for a Qualified Health Plan, Individual Enrollment Agreement for a Qualified Health Plan