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This plan does not cover the following services, treatments and supplies:

  • Services which are not dentally necessary, those which do not meet generally accepted standards of care for treating the particular dental condition, or which MetLife deems experimental in nature;
  • Services for which you would not be required to pay in the absence of dental insurance;
  • Services or supplies received by you or your dependent before the dental insurance starts for that person;
  • Services which are neither performed nor prescribed by a dentist except for those services of a licensed dental hygienist which are supervised and billed by a dentist and which are for:
    • Scaling and polishing of teeth; or
    • Fluoride treatments;
  • Services or appliances which restore or alter occlusion or vertical dimension;
  • Restoration of tooth structure damaged by attrition, abrasion or erosion;
  • Restorations or appliances used for the purpose of periodontal splinting;
  • Counseling or instruction about oral hygiene, plaque control, nutrition and tobacco;
  • Personal supplies or devices including, but not limited to: water picks, toothbrushes, or dental floss;
  • Decoration, personalization or inscription of any tooth, device, appliance, crown or other dental work;
  • Missed appointments;
  • Services:
    • Covered under any workers’ compensation or occupational disease law;
    • Covered under any employer liability law;
    • For which the employer of the person receiving such services is not required to pay; or
    • Received at a facility maintained by the employer, labor union, mutual benefit association, or VA hospital;
  • Services covered under other coverage provided by the employer;
  • Temporary or provisional restorations;
  • Temporary or provisional appliances;
  • Prescription drugs;
  • Services for which the submitted documentation indicates a poor prognosis;
  • The following when charged by teh dentist on a separate basis:
    • Claim form completion;
    • Infection control such as gloves, masks, and sterilization of supplies; or
    • Local anesthesia, non-intravenous conscious sedation or analgesia such as nitrous oxide.
  • Caries susceptibility tests;
  • Initial installation of a fixed and permanent denture to replace one or more natural teeth which were missing before such person was insured for dental insurance, except for congenitally missing natural teeth;
  • Other fixed denture prosthetic services not described elsewhere in the certificate;
  • Precision attachments, except when the precision attachment is related to implant prosthetics;
  • Initial installation of a full or removable denture to replace one or more natural teeth which were missing before such person was insured for dental insurance, except for congenitally missing natural teeth;
  • Addition of teeth to a partial removable denture to replace one or more natural teeth which were missing before such person was insured for dental insurance, except for congenitally missing natural teeth;
  • Fixed and removable appliances for correction of harmful habits;
  • Appliances or treatment for bruxism (grinding teeth), including but not limited to occlusal guards and night guards;
  • Diagnosis and treatment of temporomandibular joint (TMJ) disorders;
  • Orthodontics;
  • Duplicate prosthetic devices or appliances;
  • Replacement of a lost or stolen appliance, cast restoration, or denture; and
  • Intra and extraoral photographic images.

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