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One visit each calendar year from 36 months of age through age 18.

Repair of partial or complete dentures (once each 12 months).

Removal of seven or more permanent teeth, removal of impacted or unerupted teeth imbedded in bone, periodontal surgery involving two or more gum quadrants and adjunctive surgical procedures.

Repair of partial or complete crowns and bridges (once each 12 months).

Six visits from ages one through 5.

One visit every two calendar years for ages 6 through 10.

One visit each calendar year for ages 11 through 18.

One exam each calendar year from age 19 through age 21.

One exam every five calendar years from age 22 through age 29.

One exam every two calendar years from age 40 through age 49.