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Agmt74 California Dental Servic
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Agmt74 California Dental Servic
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Last modified
7/5/2005 2:53:21 PM
Creation date
6/10/2002 11:15:18 AM
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Template:
Agreement
Contractor Name
California Dental Service
PROJECT NAME
dental care service
RMP File Number
304
Date
2/1/1974
Reso Ref
7144
Box
2450
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IV. LIMITATIONS <br /> The benefits as outlined are subject to the following limitations: <br /> (a) X-rays: <br /> <br /> Complete mouth x-rays are provided only once in a three {3) year period, unless special need is shown. <br />Supplementary bite-wing x-rays are provided upon request but not more than once every six (6) months. <br /> <br /> (b) Prosthodontics: <br /> <br /> Replacement will be made of an existing prosthodontic appliance only if it is unsatisfactory and cannot be <br />made satisfactory. Prosthodontic appliances (including partial and complete dentures, crowns, and bridges) will be <br />replaced only after five (5) years have elapsed following any prior provision of such appliances under any CDS program. <br /> <br /> (c) Optional: <br /> <br /> In all cases in which the patient selects a more expensive plan of treatment than is customarily provided, <br />CD$ will pay the applicable percentage of the lesser fee. The patient is responsible for the remainder of the dentist's fee. <br /> <br /> (1) Partial Dentures. CDS will provide a standard cast chrome or acrylic partial denture or will allow the <br />cost of such procedure toward a more complicated or precision appliance that patient and dentist may choose to use. <br /> <br /> (2) Complete Dentures. If in the construction of a denture the patient and dentist decide on personalized <br />restorations or employ specialized techniques as opposed to standard procedures, CDS will allow an appropriate amount <br />for the standard denture toward such treatment and the patient must bear the difference in cost. <br /> <br /> (3) Occlusion. CDS will allow the cost of restorations required to replace missing teeth. Procedures, <br />appliances or restorations necessary to increase vertical dimension and/or restore or maintain the occlusion are <br />considered optional, and the cost is the responsibility of the patient. Such procedures include, but are not limited to, <br />equi(ibration, periodontal splinting, restoration of tooth structure lost from attrition, and restoration for malalignment <br />of the teeth. <br /> <br /> (4) Implants. If implants are utilized, CDS will allow the cost of a standard complete or partial denture <br />toward the cost of implants and appliances constructed in association therewith. CDS will not provide surgical removal of <br />implants. <br /> <br /> -2- <br /> <br /> <br />
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