Page 85

UNOFFICIAL 1737-85 (9) Drugs administered by the dentist in the dentist's office shall be covered at the rate of fifty cents for each drug plus the cost of the drug; (10) Dental prosthesis limited to crowns, space maintainers, partial or full dentures, adjustments and repair, subject to the following limitations:

(A) Partial dentures shall be limited to fill the space due to the loss of one or more anterior teeth and to fill the space due to the loss of two or more

posterior teeth exclusive of third molars; (B) One partial or full denture shall be allowed per arch per recipient in any five year period. This is allowed when existing dentures cannot be repaired or adjusted; (C) Temporary partial dentures shall be allowed only when teeth have been extracted recently and shall be subject to the maximum benefits for dentures; (D) Denture relines are limited to one per denture every two years; (E) Precious, semi-precious, and non-precious metal cast crowns shall be limited to permanent first and second molars; (F) Overdentures shall not be covered; and

(G) Space maintainers are limited to children age fourteen and under to hold the space for the eruption of the

permanent cuspids, pre-molars or first molars due to premature loss of the deciduous predecessor; and (11) Consultation and dental surgery with the following limitations: (A) Routine postoperative visits shall be considered part of the total surgical procedure and shall not be separately compensable; and (B) Vestibuloplastys, skin grafts, bone grafts, and implants shall not be covered except when one or more is part of the treatment for fractured jaws.

(c) Specific dental services not covered by the department shall include the following: (1) Orthodontic services except following repair of a cleft palate or other severe