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retention and restoration, and may not exceed five surfaces per tooth;

(5) periodontics, including treatment of pain or acute infection of supporting tissues of the teeth, including gingivitis, periodontitis, and periodontal abscess;

(6) oral surgery; under this paragraph,

(A) prior authorization from the department is required for extractions; and

(B) local anesthesia, materials, and routine postoperative care are considered components of a complete surgical procedure and may not be billed separately;

(7) professional consultation, if medically necessary or if requested by the department. (c) Prior authorization from the department is required for prosthodontic services. Except as specifically excluded under (g) of this section, the department will pay up to $1,150 per state fiscal year for prosthodontic services provided to a recipient 21 years of age or older, and up to twice the annual limit if one annual limit is not adequate to cover the cost of the provision of upper and lower dentures at the same time. If the department authorizes use of up to twice the annual limit for dentures, the maximum amount authorized is the remaining amount from the current fiscal year and the entire amount allotted for the succeeding fiscal year limit. In the succeeding fiscal year, the department will not authorize a new or additional annual limit. The department will pay for prosthodontic services identified in Fee Schedule: Prosthodontic Adult Dental Services, adopted by reference in 7 AAC 160.900, as follows:

(1) a complete denture, maxillary;

(2) a complete denture, mandibular;

(3) a partial denture, maxillary;

(4) a partial denture; mandibular;

(5) replacement of a complete or partial denture only if the existing denture is unusable and only once per five years, unless the department determines, based on medical justification submitted with the prior authorization request, that a delay will endanger the life of the recipient;

(6) replacement of a partial denture with a complete denture not earlier than five years after payment for the partial denture, unless the department determines, based on medical justification submitted with the prior authorization request, that a delay will endanger the life of the recipient;

(7) a denture within the same dental arch no more than three times per lifetime, unless the department determines, based on medical justification submitted with the prior authorization request, that a delay will endanger the life of the recipient;

(8) adjustments to a complete or partial denture not earlier than six months following the seatment date of the denture and not more than four times per fiscal year;

(9) rebase and reline procedures of a complete or partial denture not earlier than six