Periodontal appliances Sample Clauses

Periodontal appliances. 6. Oral orthotic appliances, unless specifically listed as a Covered Dental Service.
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Periodontal appliances. We will pay eligible expenses for appliances designed for the correction and treatment for the grinding and clenching of teeth. BENEFIT LEVEL A LEVEL B LEVEL C Reimbursement level – 50% 80% Periodontal appliances – One in any 36-month period based on the last date of service One in any 36-month period based on the last date of service Repair and reline of periodontal appliances – Included Included
Periodontal appliances. Appliances designed for the correction and Treatment for the grinding and/or clenching of teeth. BENEFIT LEVEL A LEVEL B LEVEL C Reimbursement Level – 50% 80% Periodontal appliances – One (1) per Participant in any thirty-six (36) month period based on the last date of service One (1) per Participant in any thirty-six (36) month period based on the last date of service Repair and reline of periodontal appliances – Included Included OCCLUSAL EQUILIBRATION The adjustment of biting surfaces to correct and align the way your upper and lower teeth bite together. BENEFIT LEVEL A LEVEL B LEVEL C Reimbursement Level – 50% 50% Occlusal Equilibration – Four (4) units in any twelve (12) month period based on the last date of service Four (4) units in any twelve (12) month period based on the last date of service PROSTHODONTIC SERVICES The replacement of missing natural teeth with artificial appliances. BENEFIT LEVEL A LEVEL B LEVEL C Reimbursement Level – 50% 50% General prosthodontic exam – One (1) in any sixty (60) month period based on the last date of service One (1) in any sixty (60) month period based on the last date of service Specific prosthodontic exam One (1) in any twelve (12) month period based on the last date of service One (1) in any twelve (12) month period based on the last date of service REMOVABLE PROSTHODONTIC APPLIANCES BENEFIT LEVEL A LEVEL B LEVEL C Partial and complete dentures – One (1) service per arch in any sixty (60) month period based on the last date of service One (1) service per arch in any sixty (60) month period based on the last date of service This Benefit includes partial and complete dentures when we determine that there is such extensive loss of remaining teeth or change in supporting tissues that the existing appliance cannot be made satisfactory. DENTURE SERVICES Denture services are rendered for maintaining and adjusting dentures. BENEFIT LEVEL A LEVEL B LEVEL C Rebasing and resetting – One (1) per arch in any sixty (60) month period One (1) per arch in any sixty (60) month period Adjustments Two (2) adjustments per one (1) month Two (2) adjustments per one (1) month • Rebasing and resetting is only included provided at least five (5) years has lapsed from placement of existing denture or following any prior provision paid by us. • Adjustments are only included provided at least three (3) months has lapsed following provision of a denture paid for by us. • Major repairs and additions are included where further impression is...

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