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<br />4.5 <br /> <br />4.6 <br /> <br />4.7 <br /> <br />4.8 <br /> <br />------- <br />-- <br /> <br />LIMITATIONS ON BASIC BENEFITS: <br /> <br />a) <br /> <br />Periodontal procedures which include cleaning are limited under <br />Section 4. 11 (a). <br /> <br />b) <br /> <br />Sealants Benefits include the application of sealants only to <br />permanent first and second molars without caries (decay), without <br />restorations and with the occlusal surface intact, for first molars up <br />to age nine and second molars up to age 14. Sealant Benefits do not <br />include the repair or replacement of a sealant on any tooth within <br />three years of its application. <br /> <br />CROWNS, JACKETS, INLAYS, ONLA YS, AND CAST <br />RESTORATIONS. 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 Crowns, Jackets, Inlays, Onlays, and <br />Cast Restorations Benefits: <br /> <br />Crowns, Jackets, Inlays, Onlays, and Cast Restorations for treatment of <br />carious lesions (visible destruction of hard tooth structure resulting from the <br />process of dental decay) which cannot be restored with amalgam, synthetic <br />porcelain, or plastic restorations. <br /> <br />LIMITATION ON CROWNS, JACKETS, INLAYS, ONLA YS, AND <br />CAST RESTORATIONS: <br /> <br />A crown, jacket, inlay, onlay, or cast restoration will be replaced only after <br />five years have passed since it was provided under any Delta program. <br /> <br />PROSTHODONTIC BENEFITS. Delta agrees to satisfy 80% of the <br />Dentist's Usual, Customary, and Reasonable fees or of the fees actually <br />charged, whichever is less, for the following Prosthodontic Benefits: <br /> <br />Procedures for construction or repair of fixed bridges, partial or complete <br />dentures. <br /> <br />12 <br />