Routine Treatments
Covered Dental Expenses
Charges for reasonable and customary services and specified supplies shall be considered covered expenses when incurred by you or a covered Dependent. Eligible expenses include Basic and Preventive Treatment, Endodontics, Periodontics, Oral Surgery, Major Restorative and Prosthodontics. An expense is eligible to the extent that coverage is not prohibited by provincial health insurance plans or because of other limitations described below.
| Percent Payable | |
|---|---|
|
Basic Procedures Calendar Year Maximun for both Basic and Major procedures combined Complete examination Recall or Specific exam Full mouth x-ray Bitewing x-rays Scaling or root planning Pit & Fissure sealants study casts relining and rebasing of existing dentures |
100% $2,000 once every 24 months once every 9 months once every 24 months once every 6 months 8 units per year once per tooth, under 18 once every 12 months once every 12 months |
The following are considered Basic Procedures:
- oral examinations including scaling and cleaning of teeth
- topical application of sodium or stannous fluoride
- dental x-rays: single diagnostic x-rays; Panorex/complete series
- consultations
- extractions
- oral surgery including excision of impacted teeth
- amalgam, acrylic, silicate or composite fillings
- retentive pins
- anaesthesia where reasonably and customarily required in connection with other covered procedures
- occlusal equilibration
- periodontal scaling
- treatment of periodontal and other diseases of gums and tissues of the mouth
- caries, trauma and pain control
- emergency endodontic procedures and root canal therapy
- prefabricated full coverage restorations for primary teeth
- stainless steel crown restorations on primary teeth
- space maintainers for missing primary teeth and habit breaking appliances
- pit and fissure sealants for Dependent Children under the age of 18 only
- study casts, once every 12 months
- relining and rebasing of existing dentures, once every 24 months
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