Basic Restorative Care Services

Consultations (two per calendar year under the PDP and DMO; no frequency limit under the DHMO);
Extractions;
Fillings;
Injections of antibiotic drugs; (Please Note: The DMO and PDP cover injections of antibiotic drugs as a Major Restorative Care Service);
Most periodontal or other gum disease treatment;
Periodontal maintenance (four visits per calendar year under PDP combined with regular cleanings; under DMO and DHMO, two visit per calendar year covered only after active periodontal therapy);
Oral surgery (except as covered by the Medical Plan section);
Administration of general anesthesia in conjunction with oral surgery when medically necessary (may be subject to certain limits as defined by the carrier);
Periodontal scaling/root planing (one per quadrant per 24 months under PDP and DMO; limited to 4 quadrants per consecutive 12 months under DHMO);
Periodontal surgery (one per quadrant per 36 months under PDP and DMO; one per site, or per tooth, under DHMO);
Repair or recementing of crowns, inlays, or onlays; dentures; or bridgework;
Relines/rebases
MetLife PDP and Aetna DMO: one per denture per 36 months, after six months from installation
Cigna DHMO: one per denture per 36 months, within first six months after insertion; replacement limit of one every five years; and
Root canal treatments. (Please Note: The Dental DMO/DHMO Option covers root canal as a Basic Care Service. The PDP Option covers root canal as a Major Restorative Care Service.)