ODS Health Plans of Oregon

Index | Dental Rates | Premier Benefits | Preferred PPO Benefits | Exclusions | Brochure & Application

Limitations and Exclusions for Individual Dental Plans

• If an eligible person selects a more expensive plan of treatment than is usual and customary, Oregon Dental Service will pay the applicable percentage of the usual and customary fee for the less expensive treatment. The patient will then be responsible for the remainder of the dentist's fee.
• Examination and bitewing x-rays limited to once every six months.
• Full mouth x-rays limited to once every three years.
• Prophulaxis (cleanings) limited to once every six months.
• Fluoride application limited to once every six months.
• Sealant benefits are limited to the occlusal surfaces of unrestored permanet bicuspids and first and second molars.  Benefits limited to one sealant per tooth, during any five-year period.
• No benefits are provided for plaque control and oral hygiene, or dietary instructions.
• A prosthetic device or crown will be covered only once in a five-year period provided the toot has not been crowned within the past five years.
• Surgical placement or removal of implants.
• Services started prior to the date the individual became eligible for services under the program are not covered.
• Hypnosis, pre-medications or anlagesia anesthetics, or any prescribed drugs are excluded.
• Hospital costs or any additional fees charged by the dentist because the patient is hospitalized are excluded.
• Experimental procedures are not covered.
• Missed or broken appointments are not covered.
• Orthodontic services are not covered.
• Services for cosmetic reasons are not covered.
• Claims submitted more than 15 months after the date of rendition of service are not covered.
• All other services or supplies not specifically covered are excluded

Refer to your policy for a complete listing of limitations and exclusions.