Dental Services. The following dental services are not covered, except as described under Dental Services in Section 3: • Dental injuries incurred as a result of biting or chewing. • General dental services including, but not limited to, extractions including full mouth extractions, prostheses, braces, operative restorations, fillings, frenectomies, medical or surgical treatment of dental caries, gingivitis, gingivectomy, impactions, periodontal surgery, non-surgical treatment of temporomandibular joint dysfunctions, including appliances or restorations necessary to increase vertical dimensions or to restore the occlusion. • Panorex x-rays or dental x-rays. • Orthodontic services, even if related to a covered surgery. • Dental appliances or devices. • Preparation of the mouth for dentures and dental or oral surgeries such as, but not limited to, the following: o apicoectomy, per tooth, first root; o alveolectomy including curettage of osteitis or sequestrectomy; o alveoloplasty, each quadrant; o complete surgical removal of inaccessible impacted mandibular tooth mesial surface; o excision of feberous tuberosities; o excision of hyperplastic alveolar mucosa, each quadrant; o operculectomy excision periocoronal tissues; o removal of partially bony impacted tooth; o removal of completely bony impacted tooth, with or without unusual surgical complications; o surgical removal of partial bony impaction; o surgical removal of impacted maxillary tooth; o surgical removal of residual tooth roots; and o vestibuloplasty with skin/mucosal graft and lowering the floor of the mouth. Dialysis Services • The following dialysis services received in your home: o installing or modifying of electric power, water and sanitary disposal or charges for these services; o moving expenses for relocating the machine; o installation expenses not necessary to operate the machine; and o training in the operation of the dialysis machine when the training in the operation of the dialysis machine is billed as a separate service. • Dialysis services received in a physician’s office.
Dental Services. Pediatric dental benefits for Members up to age 19 are described in Section 2. Benefits will be provided to all Members for the following: Accidental Injury
Dental Services. Dental services are critical to ensuring the overall health of IHCP members. As such, dental services are a covered benefit under the Hoosier Care Connect program per Exhibit 3 Program Description and Covered Benefits that the Contractor is responsible for managing and reimbursing. The Contractor will develop a comprehensive oral health strategy, in consultation with dental providers, that ensures appropriate utilization of this benefit by members consistent with dental standards of care.
Dental Services. Child For Members under nineteen (19) years of age The dental benefits described in this section only apply to Members until the end of the month in which the Member turns nineteen (19) years of age. See “Dental – Child Dental Services” in the SUMMARY OF BENEFITS for additional information. This Agreement covers the dental services below for Members until the end of the month in which the Member turns nineteen (19) years of age when they are performed by a licensed dentist and when they are necessary and customary, as determined by the standards of generally accepted dental practice. If there is more than one professionally acceptable treatment for Your dental condition, the Plan will cover the least expensive treatment. Benefits for pediatric oral care are covered under the dental benefit received by children under the Medi-Cal program as of 2014, pursuant to the Medi-Cal Dental Program Provider Handbook in effect during the first quarter of 2014, including coverage pursuant to the Early Periodic Screening. Your Dental Benefits Oscar does not determine whether the dental services (except orthodontic services) listed in the following sections are Medically Necessary to treat Your specific condition or restore Your dentition. When orthodontic care is covered by this Agreement, claims will be reviewed to determine if it was Medically Necessary orthodontic care. See the section “Orthodontic Care” below for more information. Your dentist may recommend or prescribe dental care services that are not covered by this Agreement, including those that are cosmetic in nature. We will cover pediatric dental benefits when medically necessary. Additional requests, beyond the stated frequency limitations shall be considered when documented dental necessity is justified due to a physical limitation and/or an oral condition that prevents daily hygiene. The decision as to what dental care treatment is best for You is solely between You and Your dentist. Pretreatment Estimate A pretreatment estimate is a valuable tool for You and Your dentist. It gives You and the dentist an idea of what Your out of pocket costs will be. This allows You and Your dentist to make any necessary financial arrangements before treatment begins. It is a good idea to get a pretreatment estimate for dental care that involves major restorative, periodontic, prosthetic, or orthodontic care. The pretreatment estimate is recommended, but not required for You to get benefits for Covered Services. A pretrea...
Dental Services. Group shall have sole responsibility for all --------------- professional dental services provided to Patients with regard to the treatment of the patient's condition, including, without limitation, the following:
Dental Services. This agreement does NOT cover: general dental services such as extractions (including full mouth extractions), prostheses, braces, operative restorations, fillings, medical or surgical treatment of dental caries, gingivitis, gingivectomy, impactions, periodontal surgery, non-surgical treatment of temporomandibular joint dysfunctions, including appliances or restorations necessary to increase vertical dimensions or to restore the occlusion;
Dental Services. Except as provided in Section 2.6.1.3 of this Agreement, dental services shall not be provided by the CONTRACTOR but shall be provided by a dental benefits manager (DBM) under contract with TENNCARE. Coverage of dental services is described in TennCare rules and regulations.
Dental Services. The term "Dental Services" shall mean dental care and services, including but not limited to the practice of general dentistry, orthodontics and all related dental care services provided by PC through PC's Dentists and other dental care providers that are retained by or professionally affiliated with PC.
Dental Services. “Dental Services” means (i) all professional dental services that, pursuant to the laws of State, must be performed by a licensed dentist and (ii) all dental-care related services that, pursuant to the laws of State, may be performed by dental auxiliaries, such as dental hygienists and dental assistants, but only if such services are performed under the general supervision of a licensed dentist. Dental Services shall include, without limitation, the practice of dentistry (general and specialist), orthodontics and all related dental care services provided by Group through Providers and dental auxiliaries.
