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Retreatment of prior root canal on permanent teeth (once per tooth in 24 months).

Root end surgery on permanent teeth (once per tooth).

Prefabricated stainless steel crowns on primary and permanent teeth (once per tooth).

Periodontal scaling and root planing (once per quadrant in 36 months).

Reline or rebase partial or complete dentures (once in 24 months).

Repair of partial or complete dentures and bridges (once in 12 months).

Recementing of crowns, inlays, onlays and fixed bridgework (once per tooth).

Simple tooth extractions (once per tooth).

Erupted or exposed root removal (once per tooth).

Surgical extractions (once per tooth). A prior approval is required for complete bony impactions.