Major Services. 1. Crowns and Inlays/Onlays: treatment of carious lesions (visible decay of the hard tooth structure) when teeth cannot be restored with amalgam or resin-based composites.
Major Services. The Plan covers eighty percent (80%) of eligible charges for the major dental services listed below: • Inlays, onlays and gold foll restorations, crowns, veneers, dentures (full and partial), dental adjustments, tissue conditioning, fixed bridges.
Major Services. 50% of the cost of crowns; on lays; bridgework; and dentures to a maximum of $2,000.00 per calendar year.
Major Services. Payable at 50% of usual, customary and reasonable charges at participating dentists: Crowns - 1/Tooth/5 Years Post and core - 1/Tooth/5 Years Inlays - 1/Tooth/5 Years 0nlays - 1/Tooth/5 Years Recement Bridge Prosthodontics - 1/Tooth/5 Years Repair of dentures – 1/Year Relining of dentures – 1/ 2 Years Repair bridge
Major Services. 1. Prosthetic Dentures
a. Complete or Partial, Fixed or Removable Partial Dentures.
b. Limited to one every 60 months.
c. Tissue conditioning.
2. Inlays, Onlays and Crowns
a. Crowns, inlays, onlays, core buildup including pins, and prefabricated post and core.
b. All limited to one per tooth every 60 months.
Major Services. (a) Major Restorative Services. Major services to rebuild and repair natural tooth structure damaged by disease or injury, such as crowns and onlays, used when teeth cannot be restored with another filling material.
Major Services. The plan reimburses 100% of the eligible expenses for: ⮚ Crowns & Inlays
1. Including the use of gold when a reasonable substitute would not result in a lower expense. ⮚ Bridges & Dentures
Major Services. 1. Prosthetic Dentures
a. Includes complete, fixed, partial or removable partial dentures.
b. Limited to one every 60 months.
2. Inlays, Onlays and Crowns
a. Crowns, inlays, onlays, core buildup including pins, and prefabricated post and core; and
b. All limited to one per tooth every 60 months.
3. Dental Implants
a. Implants must be Dentally Necessary and are covered only when the arch cannot be restored with a standard prosthesis or restoration.
b. The following implant benefits are limited to one every 60 months:
(1) endosteal, eposteal, and transosteal implants;
(2) implant supported complete or partial dentures;
(3) connecting bar;
(4) prefabricated abutment;
(5) abutment supported crowns;
(6) implant supported crowns;
(7) abutment supported retainers for dentures;
(8) implant supported retainers for dentures;
(9) implant maintenance procedures;
(10) repair of implant prosthesis;
(11) replacement of semi-precision or precision attachment;
(12) repair of implant abutment;
(13) implant removal; and
(14) implant index.
c. Implant supported complete or partial dentures.
4. Occlusal Guard
a. Limited to one every 12 months; and
b. Limited to patients that are 13 years of age and older.
5. Adjunctive General Services
a. Therapeutic drug injection
b. Treatment of complications from oral surgery in unusual circumstances (for example but not limited to, treatment of dry socket following extraction or removal of bony sequestrum ).
Major Services.
a. Complete, Fixed or Removable Partial Dentures
b. Limited to one every 60 months.
Major Services. Cast Restorations — Cast or other laboratory prepared restorations and crowns are covered only when teeth cannot be restored with a filling material. Cast restora- tions (onlays, and other laboratory prepared restora- tions); crowns (acrylic, composite glass, porcelain and gold); veneers; post and cores; crown buildups (on vi- tal or non-vital teeth when functionally necessary). There is no coverage for replacement of an existing crown, onlay, or other cast restoration which is less than 5 years old. Repair or recementing of onlays and crowns is covered for 6 months after installation. Implants — Single tooth implant is offered for initial re- placement of any missing single tooth except second and third molars and lower anterior teeth. Failed im- plant, second and third molar and lower anterior tooth replacement is not included. Benefits include the sur- gical implant placement, bone grafting to the site (if required), abutment that screws into the implant body (if one is utilized) and the prosthetic crown that is sup- ported by the surgical implant. Benefits are provided for the maintenance, repair and removal of the im- plant.
