Denture repair  70% 75% One procedure per year 
Tissue conditioning  70% 75% One procedure per year 
Occlusal adjustments 70% 75% One procedure every three years 
Oral surgery 70% 75% Two per year 
Covered dental services are subject to conditions, limitations, exclusions, and maximums. Please see your  
Evidence of Coverage for details. 
*Network dentists have agreed to provide services at anegotiated rate. If you see anetwork dentist, you  
cannot be billed more than that rate.