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EXCLUSIONS <br />S <br />Any treatment requested or appliances rude which are either not necessar F for <br />maintaining or improving dental health, or are for cosmetic purposes -unless <br />o henvise covered as a benefit <br />2. Any inpatient/ outpatient hospital charges of any kind including dentist and/or <br />physician charges. <br />3. General anesthesia. <br />4. Replacement of lost or stolen dentures, appliances or bridgework. <br />5. Treatment of malignancies, cysts and neoplasms. <br />6. Procedures, appliances, or restorations to correct congenital, developmental or <br />medically induced dental disorders, including, but not limited to, treatment of <br />n yo xnctio al, n yoskeletal, or temporornandi ular joint dysfunctions unless <br />otherwise covered as an orthodontic benefit. <br />'. Implants. <br />8. Dental treatment started prior to the member's eligibility under this Plan or after <br />member's termination. <br />Any dental ' procedure unable to be performed in the dental office because of the <br />general health and physical limits of the member, including but not limited to <br />physical or emotional resistance or allergy to all commonly utilized local <br />anesthetics; extremely contagious diseases which night endanger the staff and <br />patients of a typical general dentistry office and severe medical problems which <br />would make dental therapy at a typical general dentistry office unwise. <br />o. Whose procedures requiring fixed prostodontie restorations which are necessary for <br />complete oral rehabilitation or reconstruction. <br />11. Any. procedure not specifically listed as a covered benefit is available on fee -for. <br />service basis. <br />CA 4/91 <br />