Common use of Diagnostic and Preventive Services Clause in Contracts

Diagnostic and Preventive Services. Routine Oral Exams and Consultations Comprehensive and periodic evaluations are limited to two (2) every twelve (12) months Once a comprehensive evaluation is paid, the Member is not eligible to undergo the same service with the same Provider, unless there is a significant change in health condition or the Member is absent from the Provider for three (3) or more years. Detailed problem-focused evaluations are limited to one (1) every twelve (12) months per eligible diagnosis. Limited problem-focused evaluations are limited to one (1) every twelve (12) months. Consultations are diagnostic services provided by a Dentist or physician other than the practitioner providing the dental treatment, and are limited to one (1) every twelve (12) months. Oral Radiographs (x-rays) Complete series intraoral x-rays or panoramic film x-rays, limited to one (1) film every five (5) years. Bitewing x-rays, limited to one (1) set every twelve (12) months for Members under age nineteen (19), and one (1) set every eighteen (18) months for Members ages nineteen (19) and older. Periapical intraoral films limited to four (4) every twelve (12) months per Provider if not performed in conjunction with definitive procedures. Occlusal intraoral films limited for Members under age 8, and limited to two (2) every twelve (12) months. Oral Cleanings (Prophylaxis) Limited to two (2) every twelve (12) months. Fluoride Treatment Limited to Members under age fourteen (14), and Limited to one (1) every twelve (12) months. Sealants Limited to children under sixteen (16) years old, and only for permanent first and secondary molars, and Limited to one per tooth every three (3) years. Emergency (Palliative) Treatment Limited to two (2) per twelve (12) months in combination with pulpal debridement

Diagnostic and Preventive Services. 1. Routine Oral Exams and Consultations Consultations a. Comprehensive and periodic evaluations are limited to two (2) every twelve (12) months months b. Once a comprehensive evaluation is paid, the Member is not eligible to undergo the same service with the same Provider, unless there is a significant change in health condition or the Member is absent from the Provider for three (3) 3 or more years. . c. Detailed problem-focused evaluations are limited to one (1) every twelve (12) months per eligible diagnosis. . d. Limited problem-focused evaluations are limited to one (1) every twelve (12) months. . e. Consultations are diagnostic services provided by a Dentist dentist or physician other than the practitioner providing the dental treatment, and are limited to one (1) every twelve (12) months. 2. Oral Radiographs (x-rays) ) a. Complete series intraoral x-rays or panoramic film x-rays, limited to one (1) film every five (5) years. . b. Bitewing x-rays, limited to one (1) set every twelve (12) months for Members under age nineteen (19), and one (1) set every eighteen (18) months for Members ages nineteen (19) 19 and older. . c. Periapical intraoral films limited to four (4) every twelve (12) months per Provider if not performed in conjunction with definitive procedures. . d. Occlusal intraoral films limited for Members under age 8, and limited to two (2) every twelve (12) months. 3. Oral Cleanings (Prophylaxis) ) a. Limited to two (2) every twelve (12) months. b. One additional cleaning during the Policy Year will be allowed for Members that are under the care of a medical professional during pregnancy 4. Fluoride Treatment Treatment a. Limited to Members under age fourteen (14), and b. Limited to one (1) every twelve (12) months. 5. Sealants Sealants a. Limited to children under sixteen (16) 16 years old, and only for permanent first and secondary molars, and and b. Limited to one per tooth every three (3) years. 6. Emergency (Palliative) Treatment Limited to two (2) 2 per twelve (12) 12 months in combination with pulpal debridement