Page 69 - APPENDICES for Diane Falten
P. 69
PREVENTIVE DENTAL
Care to prevent or nd problems with your teeth and gums.
Oral exam Not covered
Cleaning Not covered
Fluoride treatment Not covered
Dental x-rays Not covered
COMPREHENSIVE DENTAL
Care to maintain or treat problems with your teeth and gums.
Non-routine services Not covered
Diagnostic services Not covered
Restorative services Not covered
Endodontics Not covered
Periodontics Not covered
Extractions Not covered
Prosthodontics, other Not covered
oral/maxillofacial surgery,
& other services
