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One complete initial oral exam.

Single tooth x-rays as needed.

Bitewing x-rays once each six months.

Full-mouth x-rays, seven or more films, or panoramic x-rays with bitewing x-rays, once each 60 months.

Emergency exams.

Study models and casts used in planning treatment (once each 60 months).

Silver amalgam fillings (one filling for each tooth surface each 12 months).

Composite resin fillings on front teeth and, the amount allowed for amalgram fillings toward the cost of composite resins fillings on bicuspids and molars (one filling for each tooth surface each 12 months).

Pin retention for fillings.

This health plan covers preventive dental services furnished by a dentist. These covered services include: