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Restorative Services such as:

Amalgam fillings (one filling per tooth surface in 12 months).

Composite resin fillings on front teeth (one filling for each tooth surface each 12 months). For services effective on and after July 1, 2007, this includes single-surface composite resin fillings on all teeth.

Pin retention for fillings.

Stainless steel crowns on primary teeth.

Stainless steel crowns on first permanent molars for members under age 16.

Oral Surgery such as:

Tooth extractions.

Root removal.

Biopsies.