DENTAL CARE AND TREATMENT. Dental benefits available to all [Members] The following services are covered for all [Members] when rendered by a [Network] Practitioner [upon prior Referral by a [Member's] Primary Care Provider]. We cover:
DENTAL CARE AND TREATMENT. This Dental Care and Treatment provision applies to all [Members]. The following services are covered when rendered by a [Network] Practitioner [upon prior Referral by a [Member's] Primary Care Provider]. We cover: the diagnosis and treatment of oral tumors and cysts; and the surgical removal of bony impacted teeth. We also cover treatment of an Injury to natural teeth or the jaw, but only if: the Injury was not caused, directly or indirectly by biting or chewing; and all treatment is finished within 6 months of the later of:
DENTAL CARE AND TREATMENT. All procedures, treatment, and Surgery that is considered to be within the scope of the practice of dentistry. Dentistry is a practice in which a person: ◼ Is represented as being able to diagnose, treat, correct, operate, or prescribe for any disease, pain, injury, deficiency, deformity, or physical condition of the human teeth, alveolar process, gums, or jaws or associated parts and offers or undertakes by certain means to diagnose, treat, correct, operate, or prescribe for any disease, pain, injury, deficiency, deformity, or physical condition of the same; ◼ Takes impressions of the human teeth or jaws or performs any phase of any operation incident to replacing a tooth or part of a tooth or associated tissues by means of a filling, crown, denture, or other appliance; or ◼ Furnishes, supplies, constructs, reproduces, or repairs or offers to furnish, supply, construct, reproduce, or repair prosthetic dentures, bridges, or other substitute for natural teeth to the user or prospective user. Dependent – A person ⎯ other than the Subscriber ⎯ whom We have accepted for coverage as shown in the Schedule of Eligibility. Diagnostic Service – Radiology, laboratory, and pathology services and other tests or procedures that We recognize as accepted medical practice, given because of specific symptoms, and which are directed toward detecting or monitoring a definite condition, illness, or injury. A Provider must order a Diagnostic Service before it is delivered. Durable Medical Equipment – Items and supplies used to serve a specific therapeutic purpose in treating an illness or injury. The equipment must be: ◼ able to withstand repeated use; ◼ generally not useful to someone who does not have an illness, injury, or disease; and ◼ appropriate for use in the patient’s home. Effective Date – The date coverage begins under this Plan. The 60-day Waiting Period begins on the Effective Date. Elective Admission – Any Hospital Admission ⎯ whether it is for medical or surgical care ⎯ for which a reasonable delay will not unfavorably affect the outcome of the treatment.
DENTAL CARE AND TREATMENT. This Dental Care and Treatment provision applies to all Members. The following services are covered when rendered by a Network Practitioner upon prior Referral by a Member's Primary Care Provider. We cover:
DENTAL CARE AND TREATMENT. The following services are covered when rendered by a [Network] Practitioner [upon prior Referral by a [Member's] Primary Care Physician]. We cover:
DENTAL CARE AND TREATMENT. This Dental Care and Treatment provision applies to all [Members]. The following services are covered when rendered by a [Network] Practitioner [upon prior Referral by a [Member's] Primary Care Physician]. We cover: the diagnosis and treatment of oral tumors and cysts; and the surgical removal of bony impacted teeth. We also cover treatment of an Injury to natural teeth or the jaw, but only if: the Injury was not caused, directly or indirectly by biting or chewing; and all treatment is finished within 6 months of the date of the Injury. Treatment includes replacing natural teeth lost due to such Injury. But in no event do We cover orthodontic treatment.
DENTAL CARE AND TREATMENT. The following services are covered when rendered by a [Network] Practitioner [upon prior Referral by a [Member's] Primary Care Physician]. We cover: the diagnosis and treatment of oral tumors and cysts; and the surgical removal of bony impacted teeth. We also cover treatment of an Injury to natural teeth or the jaw, but only if: the Injury was not caused, directly or indirectly by biting or chewing; and all treatment is finished within 6 months of the date of the Injury. Treatment includes replacing natural teeth lost due to such Injury. But in no event do We cover orthodontic treatment. For a [Member] who is severely disabled or who is a Child under age 6, We cover: general anesthesia and Hospitalization for dental services; and dental services rendered by a dentist regardless of where the dental services are provided for a medical condition covered by this Contract which requires Hospitalization or general anesthesia.
DENTAL CARE AND TREATMENT. Dental benefits available to all [Members] The following services are covered for all [Members] when rendered by a [Network] Practitioner [upon prior Referral by a [Member's] Primary Care Provider]. We cover: the diagnosis and treatment of oral tumors and cysts; and the surgical removal of bony impacted teeth. We also cover treatment of an Injury to natural teeth or the jaw, but only if: the Injury was not caused, directly or indirectly by biting or chewing; and all treatment is finished within 6 months of the date of the Injury. Treatment includes replacing natural teeth lost due to such Injury. But in no event do We cover orthodontic treatment. [Dental Benefits available to [Members] through the end of the month in which the Member turns age 19 Subject to the applicable Deductible, Coinsurance or Copayments shown on the Schedule of Services and Supplies, We cover the diagnostic, preventive, restorative, endodontic, periodontal, prosthodontic, oral and maxillofacial surgical, orthodontic and certain adjunctive services in the dental benefit package as described in this provision for covered persons through the end of the month in which the Member turns age 19. Dental services are available from birth with an age one dental visit encouraged. A second opinion is allowed. Emergency treatment is available without prior authorization. Emergency treatment includes, but may not be limited to treatment for: pain, acute or chronic infection, facial, oral or head and neck injury, laceration or trauma, facial, oral or head and neck swelling, extensive, abnormal bleeding, fractures of facial bones or dislocation of the mandible. Diagnostic and preventive services are linked to the provider, thus allowing a member to transfer to a different provider/practice and receive these services. The new provider is encouraged to request copies of diagnostic radiographs if recently provided. If they are not available radiographs needed to diagnose and treat will be allowed. Denials of services to the dentist shall include an explanation and identify the reviewer including their contact information. Services with a dental laboratory component that cannot be completed can be considered for prorated payment based on stage of completion. Unspecified services for which a specific procedure code does not exist can be considered with detailed documentation and diagnostic materials as needed by report. Services that are considered experimental in nature will not be considered. This Poli...
DENTAL CARE AND TREATMENT. All procedures, treatment, and Surgery considered to be within the scope of the practice of dentistry, which is defined as that practice in which a person:
