every three years 
Scaling –generalized 
inflammation  70% 75% One procedure every three years 
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. 
Out-of-network dentists have not agreed to provide services at contracted fees. Benefits received