"Expense" means a charge a person is legally obligated to pay. Expenses are applied in the order in which they are incurred. Expenses are deemed to be incurred on the date the service or supply is furnished, with these exceptions:

• for a non-orthodontic appliance or its modification — on the date the master impression is made;
• for a crown, bridge, or inlay or onlay restoration — on the date the teeth are prepared;
• for root canal therapy - on the date that the canal or canals are fully prepared for filling; and
• for the orthodontic service of appliance therapy - on the date the bands are placed on the dependent child's teeth.

"Eligible expense" means the following types of covered expense incurred while covered.

Type A - Preventive
Type B - Restorative
Type C - Major
Type D - Orthodontics

Type A Covered Dental Services — Preventive
An Eligible Type A Expense is one that is incurred for:

• routine oral exams if no restorative services are performed, but not more than two exams in a calendar year;
• dental x-rays, including:
• full mouth x-rays or series, but not more than once in any 36 consecutive months;
• supplementary bitewing x-rays, but not more than two series in a calendar year;
• TMJ diagnostic x-ray;
• prophylaxis (scaling and cleaning of teeth), but not more than two in a calendar year;
• topical application of fluoride, but not more than once a calendar year;
• space maintainers used to replace prematurely lost teeth for dependents through the end of the year they turn age 19. This includes adjustments made to the original space maintainer more than six months after it is installed;
• sealants for two permanent molars per lifetime for dependents through the end of the year they turn age 16.

Type B Covered Dental Services — Restorative
An Eligible Type B Restorative Expense is one that is incurred for:

• restorations of diseased teeth with amalgam, silicate, acrylic, synthetic porcelain, or composites. All restorations on one surface are considered a single restoration;
• endodontic treatment, including root canal therapy;
• treatment of periodontal and other gum and mouth tissue diseases, including periodontal surgery;
• extractions (except when associated with orthodontic treatment), including local anesthesia and routine post-operative care;
• oral surgery, including local anesthesia and routine post-operative care, but excluding oral biopsies;
• emergency palliative treatment;
• general anesthetics when needed as part of oral or dental surgery;
• antibiotic injections by the attending dentist;
• professional consulting fees if requested by an attending dentist;
• occlusal guard appliance for bruxism (teeth grinding), but not more than once per lifetime;
• occlusal orthotic adjustment.

Type C Covered Dental Services — Major
An Eligible Type C Prosthodontics Expense is one that is incurred for:

• restorations of diseased teeth with inlays, onlays, metal fillings, or crowns — but only when these teeth cannot be restored with amalgam, silicate, acrylic, synthetic porcelain, or composites;
• first installation of removable dentures needed to replace one or more natural teeth which were removed while covered under the Plan. Also included are adjustments of these dentures more than six months after they are installed.
• first installation of fixed bridgework needed to replace one or more natural teeth which were removed while covered under the Plan, including inlays and crowns as supports;
• repair or re-cementing of crowns, inlays, onlays, bridgework, or dentures;
• relining of present dentures — but only if they were installed more than six months earlier and if they have not been relined during the past 36 months;
• rebasing of present dentures — but only if they were installed more than six months earlier and if they have not been rebased during the past 36 months;
• replacement of crowns, inlays, or onlays with new ones, but only if the existing ones:
  • cannot be made usable; and
  • are at least five years old, except for crowns that must be replaced as a result of surgery.
  If a tooth fractures underneath an existing crown which is less than five years old, the replacement crown would be considered an eligible expense if the original crown could not be made usable.
• Replacement of partial dentures, full removable dentures, or fixed bridgework with new ones, or teeth added to the existing dentures or bridgework, but only if:
  • Replacement or addition of teeth is needed because one or more natural teeth were removed while covered under the Plan;
  • Existing denture or bridgework cannot be made usable and is at least five years old; or
  • Existing denture is a temporary denture that cannot be made permanent and is replaced within 12 months by a permanent denture.
  Normally, dentures will be replaced with dentures. But when only bridgework will produce a professionally adequate result, then bridgework will be the eligible expense.
• TMJ orthotic occlusal appliance (but not more than one per lifetime).