Dental plan limitations and exclusions
- Examination are limited to once every six months.
- Bitewing X-rays are limited to once every 12 months.
- Full mouth X-rays are limited to once every five years.
- Prophylaxis (cleaning) is limited to once every six months.
- Fluoride application is limited to once every 12 months to age 19.
- Surgical placement or removal of implants is not covered.
- Orthodontic services are not covered.
- Services for cosmetic reasons are not covered.
This is a benefit summary only. For a complete description of benefits, limitations and exclusions, refer to your Member Handbook.
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