Common use of COVERED SERVICES INCLUDE Clause in Contracts

COVERED SERVICES INCLUDE.  Oral Examinations  Periapical and bitewing x-rays  Topical fluoride applications for members under age 19  Prophylaxis, including cleaning, scaling and polishing  Relining of dentures  Repairs of broken removable dentures  Palliative emergency treatment  Routine fillings consisting of silver amalgam and tooth color materials; including stainless steel crowns (primary teeth)*  Simple extractions**  Endodontics-including pulpotomy, direct pulp capping and root canal therapy (excluding restoration) *Payment for an inlay, onlay or crown will equal the amount payable for a three-surface amalgam filling when the member is not covered by Dental Amendatory Rider A. **Payment for a surgical extraction or a hemisection with root removal will equal the amount payable for a simple extraction when the member is not covered by the Dental Amendatory Rider A.

COVERED SERVICES INCLUDE.  Oral Examinations  Periapical and bitewing x-rays  Topical fluoride applications for members under age 19  Prophylaxis, including cleaning, scaling and polishing  Relining of dentures  Repairs of broken removable dentures  Palliative emergency treatment  Routine fillings consisting of silver amalgam and tooth color materials; including stainless steel crowns (primary teeth)) *  Simple extractions**  Endodontics-including pulpotomy, direct pulp capping and root canal therapy (excluding restoration) *Payment for an inlay, onlay or crown will equal the amount payable for a three-surface amalgam filling when the member is not covered by Dental Amendatory Rider A. **Payment for a surgical extraction or a hemisection with root removal will equal the amount payable for a simple extraction when the member is not covered by the Dental Amendatory Rider A.

COVERED SERVICES INCLUDE.  ❑ Oral Examinations  ❑ Periapical and bitewing xX-rays  ❑ Topical fluoride applications for members under age 19  ❑ Prophylaxis, including cleaning, scaling and polishing  ❑ Relining of dentures  ❑ Repairs of broken removable dentures  ❑ Palliative emergency treatment  ❑ Routine fillings consisting of silver amalgam and tooth color materials; including stainless steel crowns (primary teeth)*  ❑ Simple extractionsextractions **  Endodontics-❑ Endodontics - including pulpotomy, direct pulp capping and root canal therapy (excluding restoration) *Payment for an inlay, onlay or crown will equal the amount payable for a three-surface amalgam filling when the member is not covered by Dental Amendatory Rider A. **Payment for a surgical extraction or a hemisection with root removal will equal the amount payable for a simple extraction when the member is not covered by the Dental Amendatory Rider A.