• Services and supplies must be appropriate and necessary, meet professionally recognized national standards of quality, and be customarily employed nationwide for the treatment of the dental condition.
• Services and supplies must be provided by, or under the direction of, a licensed dentist, licensed dental hygienist or licensed denturist operating within the scope of his or her license. Treatment must be rendered in the state in which the dentist, hygienist or denturist is licensed.

The fact that a service or supply was provided, prescribed or approved by your dental care provider does not, in itself, mean that the service or supply meets the plan’s criteria of necessary dental care. To help determine if a service or supply is covered, you may be required to provide the plan with the appropriate documentation such as pretreatment dental x-rays or chart notes. If this information is not furnished upon request, the plan may deny all or a part of the charges. Final determination of necessary dental care is made by this plan.

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