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<br />--- <br />--- <br /> <br />4.4 <br /> <br />-------- - - <br />--- <br />------ <br /> <br />----- <br /> <br />--------- - <br /> <br />(c) <br /> <br />Delta pays for full-mouth x-rays only after five years have elapsed <br />since any prior set of full-mouth x-rays was provided under any <br />Delta program. Bitewing x-rays are provided on request by the <br />Dentist, but not more than twice in a calendar year for children to <br />age 18, or once in a calendar year for adults age 18 and over while <br />the patient is an Eligible Person under any Delta program. <br /> <br />(d) <br /> <br />Diagnostic casts are a Benefit only when made in connection with <br />subsequent orthodontic treatment covered under this program. <br /> <br />BASIC BENEFITS. Delta agrees to satisfy 80% of the Dentist's Usual, <br />Customary, and Reasonable fees or of the Fees Actually Charged, <br />whichever is less, for the following Basic Benefits: <br /> <br />Oral Surgery - <br /> <br />extractions and certain other surgical procedures, <br />including preoperative and postoperative care <br /> <br />Restorative <br /> <br />amalgam, synthetic porcelain and plastic restorations <br />(fillings) for treatment of carious lesions (visible <br />destruction of hard tooth structure resulting from the <br />process of tooth decay) <br /> <br />Endodontic <br /> <br />treatment of the tooth pulp <br /> <br />Periodontic <br /> <br />treatment of gums and bones supporting teeth <br /> <br />Sealants <br /> <br />topically-applied acrylic, plastic, or composite <br />material used to seal developmental grooves and pits <br />in teeth for the purpose of preventing dental decay <br /> <br />11 <br /> <br />----- <br /> <br />- -------- <br />