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4.12 EXCLUSIONS: The following services are not benefits: a) Services for injuries or conditions which are compensable under Worker's Compensation or Employer's Liability Laws; services which are provided to the Eligible Person by an,/ Federal or State Government Agency or are provided without cost to the Eligible Person by any municipality, county or other political subdivision, except as provided in Section 1373(a) of the California Health and Safety Code. b) Services with respect to congenital (hereditary) or developmental (following birth) malformations or cosmetic surgery or dentistry for purely cosmetic reasons, including but not limited to cleft palate, maxil- lary and mandibular (upper and lower jaw) malformations, enamel hypoplasia (lack of development), fluorosis (a type of discoloration of the teeth), and anodontia (congenitally missing teeth). c) Services for restoring tooth structure lost from wear, for rebuilding or maintaining chewing surfaces due to teeth out of allgnment or occlusion, or for stabilizing the teeth. Such services include but are not limited to: equilibration and periodontal splinting. d) Prosthodontlc Services or any single procedure started prior to the date the person became eligible for such services under this Contract. e) Prescribed Drugs, premedication or analgesia. f) Experimental Procedures. g) Prophylaxis, if the eligible patient has received two prophylaxes covered by the program in the immediately preceding eleven months. h) All hospital costs and any additional fees charged by the dentist for hospital treatment. i) Charges for anesthesia, other than general anesthesia administered by a licensed dentist in connection with covered oral surgery services. j) Extra oral grafts (grafting of tissues from outside the mouth to oral tissues). k) Services with respect to treatment of disturbances of temporomandibular joints (jaw joints). 4.13 In the absence of an amendment mutually agreed upon between Applicant and CDS, no change in Benefits shall be made during a Contract Term, except as provided in paragraph 3.05. ARTICLE V -- DEDUCTIBLE, MAXIMUM AMOUNT & COORDINATION OF BENEFITS 5.01 CDS shall not be obligated to pay for or otherwise discharge, in whole or in part, the first $ 5 0.0 0 ("deductible amount") of fees for services which are Benefits received by an Eligible Person during the term hereof and otherwise covered by this Contract, which fees shall be comp_uteri on the basis of the Dentists' Usual, Customary and Reasonable fees. Such deductible amount shall not exceed $ '100 · 00 for all Eligible Persons in a single family consisting of an Eligible Employee and his Eligible Dependents, as defined. (Amount filled in, if applicable.) The deductible applies only to ,employees in unit 1.