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APPENDIX 'D' ORTHODONTIC BENEFIT RIDER In consideration of the payments specified in paragraph 1 of the attached Agreement, and subject to all of the terms and conditions thereof, except as herein otherwise specified, CDS agrees to provide Orthodontic Benefits to eligible patients, as follows: 1. Orthodontics are defined as all the necessary procedures of treatment by a licensed dentist for correction of malposed teeth of an eligible dependent child. 2. CDS will pay or otherwise discharge 6 0 % of the lesser of the usual, customary and reasonable fees or the fees actually charged for Orthodontics, provided that the amount payable to a dentist who is not a participating dentist shall not exceed 6 0 % of the amounts for the corresponding services set forth in the Orthodontic Table of Allowances, a copy of which is attached hereto, marked Exhibit 1 and incorporated herein by reference. 3. The maximum amount payable by CDS for Orthodontics rendered to an e~igible patient shall be $ 60 0 , and the limitations on maximum amounts payable during a calendar year, as specified in the attached Agreement, shall not apply to Orthodontics. 4. Exclusions. In addition to the Exclusions and Limitations stated in Appendix C to the attached Agreement, the following exctusions shall apply to Orthodontics: la)The obligation of CDS to make monthly or other periodic payments for an orthodontic treatment plan will cease upon termination of treatment for any reason prior to completion of the case. lb)The obligation of CDS to make monthly or other periodic payments for an orthodontic treatment plan begun prior to the eligibility date of the patient will be calculated on the balance of the dentist's normal payment pattern remaining at the patient's initial eligibility date. The above mentioned maximum will apply fully to this amount. (c)CDS will not make any payment for repair or replacement of an orthodontic appliance furnished under this program. (d)CDS's obligation tO make monthly or other periodic payments for Orthodontics shall terminate on the termin- ation date of this Agreement or on the date the eligible dependent child reaches age 19 or age 23, if a full-time student. Dated: Febzuary 1, 1974 California Dental Service: CTA 2-73