Extraction of teeth incidental to reducing a fracture of the jaw.
Extraction of teeth before radiation treatment of the head and neck.
Note: This benefit is limited to specific lines of business refer to the member specific benefit plan document.ĭental services that are medically necessary and incident to a covered medical service including:
Surgical removal of bony impacted teeth.
Teeth were stable and functional immediately prior to the time of the accident without evidence of decay, periodontal disease, or endodontic pathology.
Pre- and post-accident x-rays are required.
Exception: Please check the member specific benefit plan document for NJ Small Group plans for additional coverage limitations.
Treatment must be rendered within 12 months of the injury.
Dental services for the repair (not replacement) of sound and natural teeth, maxilla, mandible, and surrounding tissues following accidental injury (not including injuries caused by eating, biting, or chewing).
Exception: Please check the member specific benefit plan document for New Jersey (NJ) Small Group plans (excision of cysts and tumors associated with teeth may be covered).
Oral surgical procedures for the excision of cysts and tumors of the maxilla, mandible and surrounding tissues (cysts and tumors associated with the teeth are not covered).
Oral surgical procedures for the correction of a non-dental physiological condition which results in a severe functional impairment.
The following procedures MAY qualify for coverage under the general benefits package: The following procedures are found in Oxfords Dental policy.