Page 49 - APPENDICES for Janet Tuma
P. 49
Hearing aids - Inner ear
$0 copay
Limits apply
Hearing aids - Outer ear
$0 copay
Limits apply
Hearing aids - Over the ear
$0 copay
Limits apply
PREVENTIVE DENTAL
Oral exam
$0 copay
Limits apply
Cleaning
$0 copay
Limits apply
Fluoride treatment
Not covered
Dental x-rays
$0 copay
Limits apply
COMPREHENSIVE DENTAL
Non-routine services
Not covered
