Common use of Preventive Services Clause in Contracts

Preventive Services. Prophylaxis - teeth cleaning three (3) times in a fiscal year, four (4) times when medically necessary; Topical application of fluoride for children up to age 19, twice in a fiscal year; Space maintainers for children up to age 14. Oral exfoliate cytology (brush biopsy) will be covered when warranted from a visual and tactile examination.

Preventive Services. Prophylaxis - teeth cleaning three (3) times in a fiscal year, four (4) times when medically necessary; Topical application of fluoride for children up to age 19, twice in a fiscal year; Space maintainers for children up to age 14. Oral exfoliate cytology (brush biopsy) The following services will be covered when warranted from a visual and tactile examination.paid at the 90% benefit level:

Preventive Services. Prophylaxis - teeth cleaning three (3) times in a fiscal year, four (4) times when medically necessary; • Topical application of fluoride for children up to age 19, twice in a fiscal year; . • Space maintainers for children up to age 14. Oral exfoliate cytology (brush biopsy) will be covered when warranted from a visual and tactile examination, unless an older age is specifically authorized by the dental plan administrator.

Preventive Services. Prophylaxis - teeth cleaning three (3) times in a fiscal calendar year, four (4) times when medically necessary; Topical application of fluoride for children up to age 19, twice in a fiscal yearcalendar; Space maintainers for children up to age 14. Oral exfoliate cytology (brush biopsy) will be covered when warranted from a visual and tactile examination.