| Examination - once in six
months |
 |
| Full Mouth Series or Panoramic
X-Ray - one in 36 months |
|
| Bitewing Series - 2 per 12
month period |
|
| Prophylaxis - once in six
months, not paid on same day as scaling |
|
| Fluoride Treatment - one
in a 6 month period, to age 16 |
|
| Pit & Fissure Sealants -
molars, one application in a 24 month period, to age
16 |
|
| Replacement of Pre-existing
Missing Teeth - one year waiting period |
|
| Replacement of Prosthetic
Appliance - once in five years |
|
| Denture Reline - 6 months
after delivery, once in a three year period |
|
| Periodontal Maintenance
Procedure - following active therapy, once in 3
months |