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Dental Plan Limitations & Exclusions

Examination and bitewing X-rays are limited to once every six months.
Full mouth X-rays are limited to once every three years.
Prophylaxis (cleaning) is limited to once every six months.
Fluoride application is limited to once every six months.
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.