Prosthodontics. We Cover prosthodontic services as follows:
Prosthodontics procedures for construction of fixed bridges, partial or complete dentures and the repair of fixed bridges; implant surgical placement and removal; and for implant supported prosthetics, including implant repair and recementation.
Prosthodontics. Insurance will pay ninety percent (90%) of the Usual and Customary charges, with the employee paying the balance.
Prosthodontics. Insurance will pay one hundred percent (100%) of the Usual and Customary charges, with the employee paying the balance.
Prosthodontics. We Cover prosthodontic services as follows: • Removable complete or partial dentures, for Members 15 years of age and above, including six (6) months follow-up care; • Additional services including insertion of identification slips, repairs, relines and rebases and treatment of cleft palate; and • Interim prosthesis for Members five (5) to 15 years of age. We do not Cover implants or implant related services. Fixed bridges are not Covered unless they are required: • For replacement of a single upper anterior (central/lateral incisor or cuspid) in a patient with an otherwise full complement of natural, functional and/or restored teeth; • For cleft palate stabilization; or • Due to the presence of any neurologic or physiologic condition that would preclude the placement of a removable prosthesis, as demonstrated by medical documentation.
Prosthodontics. Reimbursement for any type of prosthesis (removable or fixed) includes follow-up examinations and adjustments for the three-month period following the date on which the prosthesis is fitted. For the laboratory expenses included in a procedure, the eligible maximum is 50% of the dental surgeon’s fee for the dental procedure code at issue and in accordance with the maximum set forth in the Fee Guide. Unless otherwise specified, any type of prosthesis is reimbursed only once per five-year period.
i) Removable prostheses Complete dentures − Standard complete dentures − Equilibrated complete dentures − Immediate complete dentures (once in a lifetime) − Immediate complete dentures (transitional, once in a lifetime) − Dentures, complete, overdenture, standard − Dentures, complete, overdenture, equilibrated − Partial dentures, acrylic (immediate, transitional or permanent, once in a lifetime) − Partial dentures, cast − Complete denture with partial denture (opposing arch) with cast (standard and equilibrated) − Removable cast partial dentures with precision attachments or semi-precision cast partial dentures − Hybrid partial dentures, cast − Dentures, complementary services − Dentures supported by implants, up to the fee for an equivalent standard denture
ii) Fixed prosthodontics and bridges (one procedure per tooth per five-year period) Fixed prosthodontics − Individual crown − Cast post − Crown or veneer repair, chairside − Recementation or removal of inlay, onlay, non-prefabricated crown, veneer or post − Prefabricated post with buildup − Pontics − Fixed bridges, complementary services − Abutments e) Oral surgery
Prosthodontics. Fixed bridges and partial or complete dentures are covered services for members under the age of 19. Replacements will be covered only if the existing fixed bridge, partial denture or complete denture meets the following criteria: it is more than five (5) years old, it is not serviceable, and it cannot be repaired. This agreement covers crowns over implants as a prosthodontic service for members under the age of 19. This agreement covers a single tooth implant as a prosthodontic service for members under the age of 19.
Prosthodontics a. An upper or lower denture is a payable benefit once per arch in a sixty (60) consecutive month period.
b. A removable partial denture or fixed partial denture (bridge) may not be provided under this Plan for any one patient more often than once per arch in a sixty (60) consecutive month period, except where the loss of additional teeth requires the construction of a new appliance.
c. Reline (process of resurfacing the tissue side of a denture with new base material) and rebase (process of refitting a denture by replacing the base material) is a benefit once in any thirty−six (36) consecutive month period for any one appliance.
d. Fixed partial dentures (bridges) and removable partial dentures are benefits for persons age sixteen (16) and over.
Prosthodontics. Fixed partial dentures (abutment crowns and pontics); removable complete and partial dentures.
Prosthodontics. (replacement of missing teeth) will not be covered under the terms of this Agreement. Orthodontia benefits will be limited to a lifetime maximum of $1,500 per eligible family member of a Bargaining Unit Member. The District shall provide Bargaining Unit Members with the Delta Dental Active PPO Network (non-network provider paid at the Delta PPO participating fee schedule.)
