Covered dental expenses shall not include expenses incurred for:

• Instruction for plaque control;
• Oral hygiene instruction;
• Bite registrations;
• Experimental or investigational dental services;
• Any services, supplies, or treatment unless prescribed by a legally qualified dentist or physician;
• Services rendered prior to the patient becoming eligible for benefits;
• Any dental procedure performed wholly or substantially for cosmetic reasons or without respect to congenital mouth form;
• Replacement of existing denture or partial denture more than once every five years;
• Placement of existing crown or fixed bridge more often than once every five years;
• Crowns, inlays, dentures bridgework or other prosthetic appliances installed or delivered more than 30 days after termination of coverage;
• Charges for crowns, inlays, dentures, bridges or other appliances to increase vertical dimension or reduce occlusion;
• Charges for multiple abutting of teeth or crowns, or teeth installed for clasping purposes only, or crowns and/or inlays installed as multiple abutments and splints to augment periodontal treatment;
• Duplicate prosthetic appliances;
• A prosthetic appliance, fixed or removable, used as an adjunct to periodontal care, unless it replaces a missing tooth;
• Charges for temporary crowns (unless tooth is fractured, and only on anterior teeth), implants and bridges or dentures involving implants, or for temporary dental services which will be considered an integral part of the final dental service rather than a separate service;
• Dental service performed by a dentist in which the Fund experiences an instance of unsatisfactory documentation or recording of services which are deemed detrimental to the Fund or the patient;

BENEFITS QUESTIONS? PLEASE CONTACT MARY AT (631) 732-6500.

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