Basic Preventive and Diagnostic Services. Oral Evaluations This plan covers an initial oral examination, a periodic oral examination, or an emergency oral examination, including diagnosis and charting, per plan year as follows: • two (2) examinations for members under age nineteen (19); • one (1) examination for members age nineteen (19) and older. Cleanings (Prophylaxis) This plan covers two (2) cleanings per plan year. Besides these two (2) cleanings provided per plan year, members who are pregnant are also provided one (1) additional cleaning during their pregnancy.
Basic Preventive and Diagnostic Services. Oral Evaluations For members under the age nineteen (19), this plan covers two (2) examinations, including diagnosis and charting, per plan year. Examinations include: • an initial oral examination; • a periodic oral examination; • an emergency oral examination; or • a telemedicine consultation by an oral surgeon. For members age nineteen (19) and older this plan covers one (1) initial, periodic, or emergency oral examination, including diagnosis and charting, per plan year. In addition, this plan covers one (1) telemedicine consultation per plan year when provided by an oral surgeon. Cleanings (Prophylaxis) This plan covers two (2) cleanings per plan year. Besides these two (2) cleanings provided per plan year, members who are pregnant are also provided one (1) additional cleaning during their pregnancy. This plan covers the following per plan year: • three (3) cleanings for members under age nineteen (19); • two (2) cleanings for members age nineteen (19) and older. Besides these two (2) cleanings provided per plan year, members who are pregnant are also provided one
Basic Preventive and Diagnostic Services. Oral Evaluations This plan covers an initial oral examination, a periodic oral examination, or an emergency oral examination, including diagnosis and charting, per plan year as follows: two (2) examinations for members under age nineteen (19); one (1) examination for members age nineteen (19) and older. Cleanings (Prophylaxis) This plan covers the following per plan year: three (3) cleanings for members under age nineteen (19); two (2) cleanings for members age nineteen (19) and older. X-rays This plan covers x-rays as indicated below: two (2) sets of bitewing x-rays per plan year for members under age nineteen (19); one (1) set of bitewing x-rays per plan year for members age (nineteen) 19 and older;
