Most dental services are not covered (see exclusion 14 under "What the Plan Doesn't Cover.")  For example, dental implants, orthodontic services, and treatment for damage to teeth or gums caused by biting, chewing, grinding, or any combination of these is not covered. However, your PEBB dental plan may cover these services. Note: Uniform Medical Plan is not affiliated with the Uniform Dental Plan (UDP). If you are enrolled in UDP, please contact UDP for information on your PEBB dental coverage.

Only the following dental services are covered:

General Anesthesia During a Dental Procedure

General anesthesia performed during a dental procedure is covered only when:

• It is provided by an anesthesiologist in a hospital or ambulatory surgery center.
• The charges for the hospital or ambulatory surgery center are covered by the plan.

Dental Procedures Performed in a Hospital or Ambulatory Surgery Center

Dental procedures performed in a hospital or ambulatory surgery center are covered only when any of the following conditions apply to the enrollee:

• Is under the age of 7 with a dental condition that cannot be safely and effectively treated in a dental office.
• Has a dental condition that cannot be safely and effectively treated in a dental office because of a physical or developmental disability.
• Has a medical condition that would put the enrollee at undue risk if the procedure were performed in a dental office.

Accidental Injuries

Repair of accidental injury to natural teeth, including evaluation of the injury and development of a treatment plan. These repairs are covered only if they are based on an evaluation and treatment plan completed within 30 days of the injury. Treatment may extend beyond 30 days if your provider determines treatment should start later or continue longer. Treatment must be completed by the end of the calendar year following the accident.

Oral Surgery

Only the following oral surgery procedures are covered, whether performed by a dentist or a medical professional:

• Excision of tumors or cysts of the jaw, cheeks, lips, tongue, gums, roof and floor of the mouth, or restorative surgery required by the excision.
• Incision of salivary glands or ducts.
• Obturator maintenance for cleft palate.
• Gum reduction for gingival hyperplasia due to Dilantin or phenytoin use.
• Jaw reconstruction due to cancer.
• Treatment of a fracture or dislocation of the jaw or facial bones.