Diagnostic and Preventive Services. Routine Oral Exams and Consultations 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 3 or more years. Detailed problem-focused evaluations are limited to one (1) every 12 months per eligible diagnosis. Limited problem-focused evaluations are limited to one (1) every 12 months. Consultations are diagnostic services provided by a dentist or physician other than the practitioner providing the dental treatment, limited to one (1) every 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 19, and one (1) set every eighteen (18) months for Members ages 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 twe nty-four
Appears in 3 contracts
Sources: Limited Benefit Contract, Limited Benefit Contract, Limited Benefit Contract