Common use of Orthodontic Age Limit Clause in Contracts

Orthodontic Age Limit. No Age Limit No Age Limit No Age Limit * When you receive services from a Nonparticipating Dentist, the percentages in this column indicate the portion of Delta Dental's Nonparticipating Dentist Fee that will be paid for those services. The Nonparticipating Dentist Fee may be less than what your dentist charges and you are responsible for that difference. ➢ Oral exams (including evaluations by a specialist) are payable twice per calendar year. ➢ Prophylaxes (cleanings) are payable twice per calendar year. Periodontal maintenance procedures are not a Covered Service for people under age 16. ➢ People with specific at-risk health conditions may be eligible for additional prophylaxes (cleanings) or fluoride treatment. The patient should talk with his or her dentist about treatment. ➢ Fluoride treatments are payable twice per calendar year for people up to age 19. ➢ Space maintainers are payable once per area per lifetime for people up to age 16. ➢ Bitewing X-rays are payable twice per calendar year for people under age 19 and once per calendar year for people age APPENDIX I 19 and older. Full mouth X-rays (which include bitewing X-rays) are payable once in any five-year period. Vertical bitewing X-rays are payable once in any three-year period. ➢ Four periapical and two occlusal X-rays are payable per calendar year. ➢ Sealants are payable twice per tooth per lifetime for the occlusal surface of first and second permanent molars up to age

Orthodontic Age Limit. No Age Limit No Age Limit No Age Limit * When you receive services from a Nonparticipating Dentist, the percentages in this column indicate the portion of Delta Dental's Nonparticipating Dentist Fee that will be paid for those services. The Nonparticipating Dentist Fee may be less than what your dentist charges and you are responsible for that difference. ➢ ⮚ Oral exams (including evaluations by a specialist) are payable twice per calendar year. ➢ ⮚ Prophylaxes (cleanings) are payable twice per calendar year. Periodontal maintenance procedures are not a Covered Service for people under age 16. ➢ ⮚ People with specific at-risk health conditions may be eligible for additional prophylaxes (cleanings) or fluoride treatment. The patient should talk with his or her dentist about treatment. ➢ ⮚ Fluoride treatments are payable twice per calendar year for people up to age 19. ➢ ⮚ Space maintainers are payable once per area per lifetime for people up to age 16. ➢ ⮚ Bitewing X-rays are payable twice per calendar year for people under age 19 and once per calendar year for people age APPENDIX I 19 and older. Full mouth X-rays (which include bitewing X-rays) are payable once in any five-year period. Vertical bitewing X-rays are payable once in any three-year period. ➢ ⮚ Four periapical and two occlusal X-rays are payable per calendar year. ➢ ⮚ Sealants are payable twice per tooth per lifetime for the occlusal surface of first and second permanent molars up to age

Orthodontic Age Limit. No Age Limit No Age Limit No Age Limit * When you receive services from a Nonparticipating Dentist, the percentages in this column indicate the portion of Delta Dental's Nonparticipating Dentist Fee that will be paid for those services. The Nonparticipating Dentist Fee may be less than what your dentist charges and you are responsible for that difference. ➢  Oral exams (including evaluations by a specialist) are payable twice per calendar year. ➢  Prophylaxes (cleanings) are payable twice per calendar year. Periodontal maintenance procedures are not a Covered Service for people under age 16. ➢  People with specific at-risk health conditions may be eligible for additional prophylaxes (cleanings) or fluoride treatment. The patient should talk with his or her dentist about treatment. ➢  Fluoride treatments are payable twice per calendar year for people up to age 19. ➢  Space maintainers are payable once per area per lifetime for people up to age 16. ➢  Bitewing X-rays are payable twice per calendar year for people under age 19 and once per calendar year for people age APPENDIX I 19 and older. Full mouth X-rays (which include bitewing X-rays) are payable once in any five-year period. Vertical bitewing X-rays are payable once in any three-year period. ➢  Four periapical and two occlusal X-rays are payable per calendar year. ➢  Sealants are payable twice per tooth per lifetime for the occlusal surface of first and second permanent molars up to age