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Prosthodontics such as:

Complete or partial dentures (once each 60 months for each arch).

Fixed bridges (once each 60 months for each tooth).

Replacement of dentures and bridges when they are installed at least 60 months after the initial placement and the existing appliance cannot be made serviceable.

Adding teeth to an existing bridge.

Temporary partial dentures to replace any of the six upper or lower front teeth if they are installed immediately following the loss of teeth and during the period of healing.

Major Restorative Services such as:

Crowns (including endosteal implants furnished on or after July 1, 2007) for members age 16 or older (once each 60 months for each tooth).

Replacement of crowns for members age 16 or older (once each 60 months for each tooth).

Metallic, porcelain and composite resin onlays for members age 16 or older (once each 60 months for each tooth).