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- -- 4.13 (e) (f) (g) (h) (i) (j) (k) (1) (m) (n) (0) ---- ----- ---- - ------ ----- - -- --- ___un - Prosthodontic services or any Single Procedure started prior to the date the person became eligible for such services under this Con- tract. Prescribed or applied therapeutic drugs, premedication or analgesia. Experimental procedures. Cleanings, if the eligible patient has received two cleanings covered by the program (Procedure Numbers 01110, 01120, 01201, 01205,01203, 01204, 04910) in any calendar year. All hospital costs and any additional fees charged by the Dentist for hospital treatment. Charges for anesthesia, other than general anesthesia administered by a licensed Dentist in connection with covered Oral Surgery services. Extra-oral grafts (grafting of tissues from outside the mouth to oral tissue). Implants (materials implanted into or on bone or soft tissue) or the removal of implants, except as provided under Section 4.9, Limitations on Prosthodontic Benefits. Diagnosis or treatment by any method of any condition related to the temporomandibular (jaw) joint or associated musculature, nerves and other tissues. Replacement of existing restorations for any purpose other than restoring active tooth decay. Orthodontic services (treatment of malalignment of teeth and/or jaws), except those services provided in accordance with the Orthodontic Benefit Rider attached hereto as Appendix C. An agreement between City of Redwood City and Delta is required to change Benefits during a Contract Term. 15 - ------ ------- -