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Oral Surgery such as:

Tooth extractions.

Root removal.

Biopsies.

Endodontics such as:

Root canal therapy on permanent teeth (once in a lifetime for each tooth).

Retreatment root canal therapy on permanent teeth (once in a lifetime for each tooth).

Therapeutic pulpotomy on primary or permanent teeth for members under age 16.

Other endodontic surgery intended to treat or remove the dental root.

Food products modified to be low protein that are medically necessary to treat inherited diseases of amino acids and organic acids for up to $5,000 for each member in each calendar year (or $2,500 for covered services furnished prior to October 28, 2008). The member may buy these food products directly from a distributor.