Common use of Diagnostic and Preventive Services Clause in Contracts

Diagnostic and Preventive Services. Diagnostic and Preventive Services provided by Participating Dentists will be covered at 100%, subject to the General Limitations section and are not subject to the Calendar Year Deductible. Clinical oral examinations, - excluding emer- gency examinations, not more than once in any period of six (6) consecutive months. Dental prophylaxis - not more than once in any period of four (4) consecutive months. (Prophy- laxes performed in conjunction with fluoridation or any other procedure and periodontal prophy- laxes shall be considered as being a prophylaxis for the purpose of applying this limitation.) X-rays - Bitewing films not more than once in any period of twelve (12) consecutive months. Full mouth series (includes 10 to 14 periapical X- rays and supplementary bitewing films) not more than once in any period of thirty-six (36) consec- utive months. In applying this thirty-six (36) month limitation, a panoramic X-ray shall be considered a full mouth series. X-rays required to diagnose a specific condition that needs treatment are not subject to the limitations stated above. Diagnostic casts not more than once in any period of sixty (60) consecutive months. Working mod- els taken in conjunction with a prosthetic or other appliance are not considered to be diagnostic casts. These Services are covered after six months of continuous coverage under the plan, except as noted under the Waiting Period Waiver and Ex- ceptions section below. Refer to the section entitled Summary of Benefits for Blue Shield of California’s payment percent- age.

Diagnostic and Preventive Services. Diagnostic and Preventive Services provided by Participating Dentists will be covered at 100%, subject to the General Limitations section and are not subject to the Calendar Year Deductible. Clinical oral examinations, - excluding emer- gency examinations, not more than once in any period of six (6) consecutive months. Dental prophylaxis - not more than once in any period of four (4) consecutive months. (Prophy- laxes performed in conjunction with fluoridation or any other procedure and periodontal prophy- laxes shall be considered as being a prophylaxis for the purpose of applying this limitation.) X-rays - Bitewing films not more than once in any period of twelve (12) consecutive months. Full mouth series (includes 10 to 14 periapical X- rays and supplementary bitewing films) not more than once in any period of thirty-six (36) consec- utive months. In applying this thirty-six (36) month limitation, a panoramic X-ray shall be considered a full mouth series. X-rays required to diagnose a specific condition that needs treatment are not subject to the limitations stated above. Diagnostic casts not more than once in any period of sixty (60) consecutive months. Working mod- els taken in conjunction with a prosthetic or other appliance are not considered to be diagnostic casts. These Services are covered after six twelve months of continuous coverage under the plan, except as noted under the Waiting Period Waiver and Ex- ceptions section below. Refer to the section entitled Summary of Benefits for Blue Shield of California’s payment percent- age.

Diagnostic and Preventive Services. Diagnostic and Preventive Services provided by Participating Dentists will be covered at 100%, subject to the General Limitations section and are not subject to the Calendar Year Deductible. Clinical oral examinations, - excluding emer- gency examinations, not more than once in any period of six (6) consecutive months. Dental prophylaxis - not more than once in any period of four (4) consecutive months. (Prophy- laxes performed in conjunction with fluoridation or any other procedure and periodontal prophy- laxes shall be considered as being a prophylaxis for the purpose of applying this limitation.) X-rays - Bitewing films not more than once in any period of twelve (12) consecutive months. Full mouth series (includes 10 to 14 periapical X- rays and supplementary bitewing films) not more than once in any period of thirty-six (36) consec- utive months. In applying this thirty-six (36) month limitation, a panoramic X-ray shall be considered a full mouth series. X-rays required to diagnose a specific condition that needs treatment are not subject to the limitations stated above. Diagnostic casts not more than once in any period of sixty (60) consecutive months. Working mod- els taken in conjunction with a prosthetic or other appliance are not considered to be diagnostic casts. composite filling); stainless steel crowns when the tooth cannot be restored with a filling material. These Services are covered after six months of continuous coverage under the plan, except as noted under the Waiting Period Waiver and Ex- ceptions section below. Refer to the section entitled Summary of Benefits for Blue Shield of California’s payment percent- age.

Diagnostic and Preventive Services. Diagnostic and Preventive Services provided by Participating Dentists will be covered at 100%, subject to the General Limitations section and are not subject to the Calendar Year Deductible. Clinical oral examinations, - excluding emer- gency examinations, not more than once in any period of six (6) consecutive months. Dental prophylaxis - not more than once in any period of four (4) consecutive months. (Prophy- laxes performed in conjunction with fluoridation or any other procedure and periodontal prophy- laxes shall be considered as being a prophylaxis for the purpose of applying this limitation.) X-rays - Bitewing films not more than once in any period of twelve (12) consecutive months. Full mouth series (includes 10 to 14 periapical X- rays and supplementary bitewing films) not more than once in any period of thirty-six (36) consec- utive months. In applying this thirty-six (36) month limitation, a panoramic X-ray shall be considered a full mouth series. X-rays required to diagnose a specific condition that needs treatment are not subject to the limitations stated above. Diagnostic casts not more than once in any period of sixty (60) consecutive months. Working mod- els taken in conjunction with a prosthetic or other appliance are not considered to be diagnostic casts. These Services are covered after six months of continuous con- tinuous coverage under the plan, except as noted under the Waiting Period Waiver and Ex- ceptions Exceptions section below. Refer to the section entitled Summary of Benefits for Blue Shield of California’s payment percent- age.

Diagnostic and Preventive Services. Diagnostic and Preventive Services provided by Participating Dentists will be covered at 100%, subject to the General Limitations section and are not subject to the Calendar Year Deductible. Clinical oral examinations, - excluding emer- gency emergen- cy examinations, not more than once in any period peri- od of six (6) consecutive months. Dental prophylaxis - not more than once in any period of four (4) consecutive months. (Prophy- laxes performed in conjunction with fluoridation or any other procedure and periodontal prophy- laxes shall be considered as being a prophylaxis for the purpose of applying this limitation.) X-rays - Bitewing films not more than once in any period of twelve (12) consecutive months. Full mouth series (includes 10 to 14 periapical X- X-rays and supplementary bitewing films) not more than once in any period of thirty-six (36) consec- utive consecutive months. In applying this thirty-six (36) month limitation, a panoramic X-ray shall be considered a full mouth series. X-rays required to diagnose a specific condition that needs treatment are not subject sub- ject to the limitations stated above. Diagnostic casts not more than once in any period of sixty (60) consecutive months. Working mod- els taken in conjunction with a prosthetic or other appliance are not considered to be diagnostic casts. These Services are covered after six twelve months of continuous coverage under the plan, except as noted under the Waiting Period Waiver and Ex- ceptions section Exceptions sec- tion below. Refer to the section entitled Summary of Benefits for Blue Shield of California’s payment percent- age. periodontitis; root planing (not prophylaxis); sub- gingival curettage, debridement, gingival and os- seous surgery (including post-surgical visits.