Following the participant's continuous coverage under the policy for the probationary period stated in the coverage schedule and after 5 years have lapsed since such prosthetic device or dental restoration was placed if the existing prosthetic device or dental restoration is unsatisfactory and cannot be made satisfactory. Services which are necessary to make an appliance satisfactory will be provided in accordance with the terms of the participant's policy. Prophylaxis, periodic oral evaluations, and bitewing x-rays are limited to two per calendar year. Sealants for application to the occlusal surface of permanent first and second molars, which are free of decay and restorations, are covered for participants under the age of 18.
Coverage is limited to one sealant per tooth during the lifetime of the participant.
In all cases in which there are alternative methods of treatment carrying different treatment costs, payment will be made only for the least costly, professionally acceptable method of treatment. Any balance of the treatment cost remains the participant's responsibility. Orthodontic diagnostic procedures and treatment are covered only for eligible dependent children under the age of 19. Benefits, not to exceed the orthodontic lifetime maximum, will be divided into equal quarterly payments for the total months of active treatment, not to exceed 24 months. Expenses Not Covered Services or supplies that are not dentally necessary.