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Other necessary oral surgery.

General anesthesia for covered oral surgery.

For All Members (regardless of age):

For Members Eligible for Pediatric Essential Beneftis:

For Other Members:

Resin crowns (once per tooth in 60 months).

Porcelain/ceramic crowns (once per tooth in 60 months).

Porcelain fused to metal/high noble crowns (once per tooth in 60 months).

Removable complete or partial dentures, including services to fabricate, measure, fix and adjust them (once in 84 months).

Fixed prosthetics once in 60 months (only if there is no other less expensive and adequate service available).