Diagnostic and Preventive Services. 1. Routine Oral Exams and Consultations
Diagnostic and Preventive Services. 7.7.1.1 Examinations (including Treatment Plan) limited to once every six (6) months.
Diagnostic and Preventive Services. Oral Exams Two periodic or comprehensive oral exams every 12 months. Once a comprehensive evaluation is paid, the Member is not eligible to undergo the same service with the same Provider, unless there is a significant change in health condition or the Member is absent from the Provider for 3 or more years. One limited problem-focused oral exam and consultations per Provider per patient per 12 months. One detailed problem-focused oral evaluation per Provider, per patient per diagnosis every 12 months. Oral Cleanings (Prophylaxis) Limited to two every 12 months. One additional cleaning during the Policy Year will be allowed for Members that are under the care of a medical professional during pregnancy.
Diagnostic and Preventive Services. Diagnostic and Preventive Services provided by Participating Dentists will be covered at 100%, subject to the General Limitations section and are not subject to the Calendar Year Deductible. Clinical oral examinations, - excluding emer- gency examinations, not more than once in any period of six (6) consecutive months. Dental prophylaxis - not more than once in any period of four (4) consecutive months. (Prophy- laxes performed in conjunction with fluoridation or any other procedure and periodontal prophy- laxes shall be considered as being a prophylaxis for the purpose of applying this limitation.) X-rays - Bitewing films not more than once in any period of twelve (12) consecutive months. Full mouth series (includes 10 to 14 periapical X- rays and supplementary bitewing films) not more than once in any period of thirty-six (36) consec- utive months. In applying this thirty-six (36) month limitation, a panoramic X-ray shall be considered a full mouth series. X-rays required to diagnose a specific condition that needs treatment are not subject to the limitations stated above. Diagnostic casts not more than once in any period of sixty (60) consecutive months. Working mod- els taken in conjunction with a prosthetic or other appliance are not considered to be diagnostic casts. Basic Services Anesthesia — General, or intravenous sedation only when provided in conjunction with a cov- ered oral surgical procedure. Basic Restorative Services — Amalgam restora- tions; synthetic restorations (i.e. silicate cement filling, porcelain filling, plastic filling and compo- site filling); stainless steel crowns when the tooth cannot be restored with a filling material. Palliative — Emergency treatment for relief of pain and sedative filling; other non-pain produc- ing emergent services, including recementation of inlay, onlay or partial coverage restoration, rece- mentation of cast or prefabricated post and core, recementation of crown, and recementation of fixed partial denture. Major Services These Services are covered after six months of continuous coverage under the plan, except as noted under the Waiting Period Waiver and Ex- ceptions section below. Refer to the section entitled Summary of Benefits for Blue Shield of California’s payment percent- age. Endodontics — Pulp capping; including pulpo- tomy or other palliative treatment and necessary X-rays and cultures, but excluding final restora- tion; root canal therapy; apicoectomy (including apical curettage). Oral Sur...
Diagnostic and Preventive Services. Routine Oral Exams and Consultations Once a comprehensive evaluation is paid, the Member is not eligible to undergo the same service with the same Provider, unless there is a significant change in health condition or the Member is absent from the Provider for 3 or more years. Limited problem-focused evaluations are limited to one (1) every twelve (12) months. Consultations are diagnostic services provided by a dentist or physician other than the practitioner providing the dental treatment, and are limited to one (1) every twelve (12) months. Oral Radiographs (x-rays) Complete series intraoral x-rays or panoramic film x-rays, limited to one (1) film per lifetime for new patients only. Bitewing x-rays, limited to one (1) set every twenty-four (24) months for Members age 19 through 29, and one (1) set every three (3) years for Members ages 30 and older. Periapical intraoral films limited to four (4) every twelve (12) months and only when taken with a problem-focused evaluation or palliative emergency treatment. Oral Cleanings (Prophylaxis) Limited to one (1) every twelve (12) months. One additional cleaning during the Policy Year will be allowed for Members that are under the care of a medical professional during pregnancy Emergency (Palliative) Treatment one (1) every twelve (12) months.
Diagnostic and Preventive Services. Routine Oral Exams and Consultations Comprehensive and periodic evaluations are limited to two (2) every twelve (12) months Once a comprehensive evaluation is paid, the Member is not eligible to undergo the same service with the same Provider, unless there is a significant change in health condition or the Member is absent from the Provider for 3 or more years. Detailed problem-focused evaluations are limited to one (1) every twelve (12) months per eligible diagnosis. Limited problem-focused evaluations are limited to one (1) every twelve (12) months. Consultations are diagnostic services provided by a dentist or physician other than the practitioner providing the dental treatment, and are limited to one (1) every twelve (12) months. Oral Radiographs (x-rays) Complete series intraoral x-rays or panoramic film x-rays, limited to one (1) film every five (5) years. Bitewing x-rays, limited to one (1) set every twelve (12) months for Members under age 19, and one (1) set every eighteen (18) months for Members ages 19 and older. Periapical intraoral films limited to four (4) every twelve (12) months per Provider if not performed in conjunction with definitive procedures. Occlusal intraoral films limited for Members under age 8, and limited to two (2) every twelve (12) months. Oral Cleanings (Prophylaxis) Limited to two (2) every twelve (12) months. One additional cleaning during the Policy Year will be allowed for Members that are under the care of a medical professional during pregnancy Fluoride Treatment Limited to Members under age 14, and Limited to one (1) every twelve (12) months. Sealants Limited to children under 16 years old, and only for permanent first and secondary molars, and Limited to one per tooth every three (3) years. Emergency (Palliative) Treatment Limited to 2 per 12 months in combination with pulpal debridement B. Basic Services Space Maintainers Limited to Members under age 14. Covered when used to maintain space as a result of prematurely lost deciduous molars and permanent first molars or deciduous molars and permanent first molars that have not, or will not, develop. Limited to one (1) every five (5) years. Basic Restorations (amalgam and resin) Replacement of restorative services only covered when they are not and cannot be made serviceable. Basic restorations will not be covered if replaced within twenty four (24) months of previous placement of any basic restoration. Prefabricated stainless steel crowns are included unde...
Diagnostic and Preventive Services. Routine Oral Exams and Consultations Comprehensive and periodic evaluations are limited to two (2) every twelve (12) months Once a comprehensive evaluation is paid, the Member is not eligible to undergo the same service with the same Provider, unless there is a significant change in health condition or the Member is absent from the Provider for 3 or more years. Detailed problem-focused evaluations are limited to one (1) every 12 months per eligible diagnosis. Limited problem-focused evaluations are limited to one (1) every 12 months. Consultations are diagnostic services provided by a dentist or physician other than the practitioner providing the dental treatment, limited to one (1) every 12 months. Oral Radiographs (x-rays) Complete series intraoral x-rays or panoramic film x-rays, limited to one (1) film every five (5) years. Bitewing x-rays, limited to one (1) set every twelve (12) months for Members under age 19, and one (1) set every eighteen (18) months for Members ages 19 and older. Periapical intraoral films limited to four (4) every twelve (12) months per Provider if not performed in conjunction with definitive procedures. Occlusal intraoral films limited for Members under age 8, and limited to two (2) every twe nty-four
Diagnostic and Preventive Services. Diagnostic and preventive services provided by Partici- pating Dentists will be covered at 100%, subject to the limitations in the General Limitations section and are not subject to the Calendar Year Deductible.
Diagnostic and Preventive Services. This plan will pay 100% of the allowed charge. There is no Deductible for these services.
Diagnostic and Preventive Services. Oral Exams One periodic, limited problem-focused or comprehensive oral exam every 6 months. One detailed problem-focused oral evaluation per patient per provider every 12 months per eligible diagnosis. Oral Cleanings (Prophylaxis) Limited to one every 6 months. One additional cleaning during the Policy Year will be allowed for Members that are under the care of a medical professional during pregnancy. Fluoride Treatment Limited to children under 19 years old, and Limited to two topical application every 12 months. Sealants Limited to children under 19 years old, and only for permanent first and secondary molars, and Limited to one per tooth every 36 months.
