Oral
Surgery – 90%
Benefits are provided for
services and supplies performed by a physician or dentist for the treatment of
the tissues of the mouth to the extent that such treatment is not covered under
the plan’s dental benefits. This includes treatment for the following
medical conditions:
- Excision
of a tumor or cyst of the jaw, cheek, lips, tongue, or roof or floor of the
mouth.
- Excision
of exostosis of the jaw and hard palate.
- Incision
and drainage of cellulitis.
- Incision
of accessory sinuses, salivary glands or ducts.
Benefits
are not
provided for:
- Services
or supplies in connection with the correction of acquired developmental or
congenital abnormalities of the jaw, or malocclusion of the jaw by orthognathic
surgery with or without bone grafting, or vestibuloplasty performed by a
physician or dentist, except as provided for under TMJ and MPDS
Treatment and Orthognathic Surgery.
- Dental
implants including surgical placement, removal or related prostheses, except as
provided for under Dental Implants.
- Extraoral
grafts (grafts from tissues outside the mouth or using artificial materials) or
tooth transplants.
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