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<br />SUNNYISLES <br />5395246 <br /> <br />City of Sunny Isles Beach <br />COVERED DENTAL SERVICES <br /> <br />After any applicable deductible is satisfied, the following dental services will be covered, at the reimbursement rate quoted. <br /> <br />Type III and Type IV procedures may be subject to a Benefit Waiting Period.* <br /> <br />TYPE I - DIAGNOSTIC & PREVENTIVE SERVICES <br />ORAL EXAMINATIONS - up to two per calendar year <br />DENTAL X-RAYS, including: <br />bitewing films - up to four films per calendar year <br />one complete full mouth or panoramic series each five years <br />PROPHYLAXIS (Routine Cleanings) - up to two per calendar year <br />FLUORIDE TREATMENTS - for dependent children through age 15 <br />one treatment per calendar year <br />SPACE MAINTAINERS <br /> <br />TYPE II - BASIC SERVICES <br />FILLINGS <br />STAINLESS STEEL CROWNS - for dependent children through age 15 <br />SEALANTS - first and second permanent molars for dependent children through age 15 <br />one application per tooth in three years <br />ORAL SURGERY - includes extractions and many dental surgeries <br />PATHOLOGY - biopsy and examination of oral tissue <br />GENERAL ANESTHESIA and I.V. sedation <br />EMERGENCY TREATMENT and consultations <br />ENDODONTICS (root canal therapy) <br />PERIODONTAL CLEANINGS - following active periodontal therapy <br />PERIODONTAL SCALING AND ROOT PLANING - one treatment in 24 months <br />PERIODONTAL SURGERY - including gingivectomy, osseous surgery, and soft tissue graft <br />REPAIR of DENTURES <br />RECEMENTATION of CROWNS and BRIDGES <br /> <br />TYPE III PROCEDURES - MAJOR SERVICES <br />CROWNS, BRIDGES, and ONLAYS <br />FULL and PARTIAL DENTURES <br />ALVEOLAR or GINGIVAL RECONSTRUCTION SURGERY <br /> <br />TYPE IV PROCEDURES - ORTHODONTICS for dependent children <br />DIAGNOSTIC SERVICES - examinations, x-rays, and casts or study models <br />TREATMENT PLAN - including orthodontic extractions <br />ORTHODONTIC APPLIANCES <br /> <br />*Where Benefit Waiting Periods are included, Prior Carrier Credit may apply. <br /> <br />The Lincoln National Life Insurance Company <br />9 <br /> <br />2/9/2009 <br />