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(12) the retreatment or adjustment, recementation, reline, rebase, replacement or repair of cast restorations, crowns and <br />• prostheses, when made by the same Dentist or dental office which provided the initial service, within 6 months of <br />the completion of the service. <br />(13) the replacement of: <br />(a) any full or partial denture, within five years; or <br />(b) fixed prosthetic (crown, inlay or onlay restoration, or fixed bridge) within eight years; <br />of the date of the last placement of these items. If a replacement is required because of an accidental dental injury <br />sustained while the Covered Person is covered under this Policy, it will be a Covered Expense. (Damage <br />resulting from biting food or other objects is not considered to be an accidental injury.) <br />(14) the insertion, maintenance or removal of implants, and any related expenses. <br />(15) specialized procedures, including: <br />(a) precision or semi- precision attachments; <br />(b) precious metals for removable appliances; <br />(c) overlays and overdentures; or <br />(d) personalization or characterization. <br />(16) duplicate prosthetics, or for initial placement or replacement of athletic mouth guards, bruxism appliances or any <br />appliance to correct harmful habits; and for replacement of: <br />(a) space maintainers; or <br />(b) misplaced, lost or stolen dental appliances. <br />(17) appliances, restorations or procedures, or their modifications, that: <br />(a) alter vertical dimension; <br />(b) restore or maintain occlusion or for occlusal adjustment or equilibration; or <br />• (c) splint teeth or replace tooth structure lost as a result of erosion, abfraction, abrasion or attrition. <br />(18) charges for services provided by: <br />(a) an ambulatory surgical facility; <br />(b) a hospital; <br />(c) any other facility; or <br />(d) an anesthesiologist. <br />(19) analgesia, sedation, hypnosis or acupuncture, for anxiety or apprehension. <br />(20) any medications administered outside the dentist's office or for prescription drugs. <br />(21) charges which do not directly provide treatment for a dental injury or condition, such as: <br />(a) the completion of claim forms; <br />(b) broken appointments; <br />(c) interest or collection charges; <br />(d) sales or other taxes or surcharges; <br />(e) education, training and supplies used for dietary or nutritional counseling, personal oral hygiene <br />or dental plaque control; <br />(f) caries susceptibility tests, bacteriologic studies, histopathologic exams or pulp vitality testing; or <br />(g) duplication of x -rays or other dental records. <br />Ll <br />GL 11- 16B -EX FL Has TMJ, (I -III) <br />21 09/01/01 <br />