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SUNNYISLES <br />1703779 City of Sunny Isles Beach <br />DENTAL LIMITATIONS & EXCLUSIONS (Continued) <br />1010. initial placement of any prosthetic appliance or fixed bridge; unless such placement is needed to replace <br />one or more functioning natural teeth extracted while the person is covered under the policy; subject to <br />the Prior Carrier Credit provision, if included in the policy. Any such appliance or fixed bridge must <br />include the replacement of the extracted tooth or teeth. <br />11. the retreatment or adjustment, recementation, reline, rebase, replacement or repair of restorations, <br />crowns and prostheses, when made by the same dentist or dental office which provided the initial service, <br />within 6 months of the completion of the service. <br />12. 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 of the date of <br />the last placement of these items. If a replacement is required because of an accidental dental <br />injury sustained while the person is covered under the 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 />13. the insertion, maintenance or removal of implants, and any related expenses. <br />14. 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 />•15. duplicate prosthetics, or for initial placement or replacement of athletic mouth guards, bruxism appliances <br />or any appliance to correct harmful habits; and for replacement of: <br />a) space maintainers; or <br />b) misplaced, lost or stolen dental appliances. <br />16. 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 />17. 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 />18. analgesia, sedation, hypnosis or acupuncture, for anxiety or apprehension. <br />19. any medications administered outside the dentist's office or for prescription drugs. <br />• <br />Jefferson Pilot Financial Insurance Company <br />FL 31 <br />11/02/01 <br />