Diagnostic – Preventive
Oral Exam  
Cleanings (every six months)  
Fluoride to age 14
X-rays

Restorative
Silver Amalgams 
Composite Fillings (front teeth) 

Endodontics
Single Root Canal  
Double Root Canal
Triple or more Root Canal Filling  
Apicoectomy

Periodontics 
Root Scaling and Planing                                     
Gingivectomy, Gingivoplasty (per quadrant)         
Osseous Surgery (per quadrant)                          

Oral Surgery Extractions
Extraction of Erupted Tooth
Extraction of Soft Bony Impaction     
Extraction of Partial Bony Impaction 
Extraction of Complete Bony Impaction

Prosthetics
Crowns 
Dentures 
Bridgework (Exclusions Apply) 

Orthodontics - Comprehensive 
To age 19 (Maximum is 24 months)