Major Restorative Services. Crowns and Onlays This plan covers single tooth crowns and onlays that are not part of a bridge to restore natural teeth. This plan covers replacements once in a sixty (60) month period if the existing crown or onlay is not serviceable and cannot be repaired. Oral Surgery Services This plan covers surgical extractions and other oral surgical procedures that are dentally necessary and meet our dental policies and related guidelines when the oral surgery is not covered under your medical insurance plan. General Anesthesia or Intravenous Sedation (IV) This plan covers in a dental office general anesthesia and intravenous sedation when rendered in conjunction with certain covered oral surgical procedures. Surgical Periodontal Services This plan covers surgical periodontal services and procedures for the treatment of tissues supporting the teeth. Most surgical periodontal services and procedures are limited to one per site/quadrant per thirty-six (36) month period.
Appears in 13 contracts
Samples: Subscriber Agreement, Subscriber Agreement, Subscriber Agreement
