PWU REPRESENTED EMPLOYEES - ODA CODES COVERED UNDER THE KINECTRICS DENTAL PLAN (DRAFT) PROCEDURE

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1 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class A Initial examination of a new patient % Class A Initial examination of a new patient % Class A Initial examination of a new patient % (2 times/person/cal yr OR Class A Re-examination of a previous patient once/person every 6 months) % (2 times/person/cal yr OR Class A Periodontal examination once/person every 6 months) % Class A Specific examination % Class A Emergency Examination % (once/person every 3 cal yrs) Class A Intraoral radiographs complete % (once/person every 3 cal yrs) Class A Intraoral radiographs complete % Class A Intraoral radiographs (1 to 15) % Class A Intraoral radiographs (1 to 15) % Class A Intraoral radiographs (1 to 15) % Class A Intraoral radiographs (1 to 15) % Class A Intraoral radiographs (1 to 15) % Class A Intraoral radiographs (1 to 15) % Class A Intraoral radiographs (1 to 15) % Class A Intraoral radiographs (1 to 15) % Class A Intraoral radiographs (1 to 15) % Class A Intraoral radiographs (1 to 15) % Class A Intraoral radiographs (1 to 15) % Class A Intraoral radiographs (1 to 15) % Class A Intraoral radiographs (1 to 15) % Class A Intraoral radiographs (1 to 15) % Class A Intraoral radiographs (1 to 15) % Class A Intraoral, Occlusal radiographs % Class A Intraoral, Occlusal radiographs % Class A Intraoral, Occlusal radiographs % Class A Intraoral, occulsal radiographs % Class A Intraoral Occlusal radiographs % Class A Intraoral Occlusal Radiographs % (2 times/person/cal yr OR Class A Intraoral, Bitewing radiographs (from 1-6 films) once/person every 6 months) % (2 times/person/cal yr OR Class A Intraoral, Bitewing radiographs (from 1-6 films) once/person every 6 months) % (2 times/person/cal yr OR Class A Intraoral, Bitewing radiographs (from 1-6 films) once/person every 6 months) % (2 times/person/cal yr OR Class A Intraoral, Bitewing radiographs (from 1-6 films) once/person every 6 months) % (2 times/person/cal yr OR Class A Intraoral, Bitewing radiographs (from 1-6 films) once/person every 6 months) % (2 times/person/cal yr OR Class A Intraoral, Bitewing radiographs (from 1-6 films) once/person every 6 months) % Class A Extraoral Radiogrphas % Class A Extraoral Radiographs % Class A Extraoral Radiographs % Class A Extraoral Radiographs % Class A Extraoral Radiographs % Class A Sinus Examination % Class A Sialography

2 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class A Sialography % Class A Sialography % Class A Use of radiopaque dyes to demonstrate lesions % Class A Use of radioopaque dyes to demonstrate lesions % Class A Use of radioopaque dyes to demonstrate lesions % Class A Temporomandibular Joint radiographs % Class A Temporomandibular Joint radiographs % (once/person every 3 cal yrs) Class A Panoramic (full mouth) radiographs % Class A Cephalometric radiographs % Class A Cephalometric radiographs % Class A Cephalometric radiographs % Class A Cephalometric radiographs % Class A Cephalometric radiographs % Class A Tracing of radiographs % Class A Tracing of radiographs % Class A Tracing of radiographs % Class A Interpretation of radiographs from another source - per unit of time % Class A Interpretation of radiographs from another source - per unit of time % Class A Interpretation of radiographs from another source - per unit of time % Class A Hand and Wrist radiographs % Class A Tomography radiographs % Class A Tomography radiographs % Class A Tomography radiographs % Class A Tomography radiographs % Class A Tomography radiographs % Class A Tests and laboratory examinations % Class A Tests and laboratory examinations % Class A Tests and laboratory examinations % Class A Tests and laboratory examinations % Class A Tests and laboratory examinations % Class A Tests and laboratory examinations % Class A Tests and laboratory examinations % Class A Diagnostic photographs % Class A Diagnostic photographs % Class A Diagnostic photographs % Class A Diagnostic photographs % Class A Diagnostic photographs % Class A Diagnostic photographs % Class A Treatment Planning % Class A Treatment Planning % Class A Treatment Planning % Class A Treatment Planning % Class A Treatment Planning % (2 times/person/cal yr) Class A Consultations % (2 times/person/cal yr) Class A Consultations % (2 times/person/cal yr) Class A Consultations % (once every 6 months) Class A Polishing % (once every 6 months) Class A Polishing % (once every 6 months) Class A Polishing % (once every 6 months) Class A Polishing % Class A Scaling limited to a maximum combined with periodontal root planing

3 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class A Scaling limited to a maximum combined with periodontal root planing % Class A Scaling limited to a maximum combined with periodontal root planing % Class A Scaling limited to a maximum combined with periodontal root planing % Class A Scaling limited to a maximum combined with periodontal root planing % Class A Scaling limited to a maximum combined with periodontal root planing % Class A Scaling limited to a maximum combined with periodontal root planing % Class A Scaling limited to a maximum combined with periodontal root planing % (once every 6 months) Class A Preventative recall packages % (once every 6 months) Class A Preventative recall packages % (once every 6 months) Class A Preventative recall packages % (once every 6 months - under Class A Preventative recall packages 18 years of age only) % (once every 6 months - under Class A Preventative recall packages 18 years of age only) % (once every 6 months - under Class A Preventative recall packages 18 years of age only) % (once every 6 months) Class A Preventative recall packages % (once every 6 months) Class A Preventative recall packages % (once every 6 months) Class A Preventative recall packages % (once every 6 months - under Class A Preventative recall packages 18 years of age only) % (once every 6 months - under Class A Preventative recall packages 18 years of age only) % (once every 6 months - under Class A Preventative recall packages 18 years of age only) % (2 times/year up to and Class A Fluoride treatment including age 18) % (2 times/year up to and Class A Fluoride treatment including age 18) % Class A Oral Hygiene Instruction % Class A Oral Hygiene Instruction % Class A Oral Hygiene Instruction % Class A Oral Hygiene Instruction % Class A Oral Hygiene Instruction % Class A Oral Hygiene Instruction % Class A Oral Hygiene Instruction % Class A Oral Hygiene Instruction % Class A Oral Hygiene Instruction % Class A Finishing Restorations % Class A Finishing Restorations % (once every 3 cal yrs, up to and including age 18 - permanent molars only) % (once every 3 cal yrs, up to and including age 18 - permanent molars only) Class A Class A Pit and Fissure sealant Pit and Fissure sealant

4 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class A Protective Mouth Guard % Class A Interproximal discing of teeth % Class A Interproximal discing of teeth % Class A Interproximal discing of teeth % Class A Interproximal discing of teeth % Class A Control of Oral Habits % Class A Control of Oral Habits % Class A Control of Oral Habits % Class A Control of Oral Habits % Class A Myofunctional Therapy % Class A Myofunctional Therapy % Class A Myofunctional Therapy % Class A Space Maintainers % Class A Space Maintainers % Class A Space Maintainers % Class A Space Maintainers % Class A Space Maintainers % Class A Space Maintainers % Class A Space Maintainers % Class A Space Maintainers % Class A Space Maintainers % Class A Space Maintainers % Class A Space Maintainers % Class A Space Maintainers % Class A Space Maintainers % Class A Space Maintainers % Class A Space Maintainers % Class A Space Maintainers % Class A Carries, Trauma and Pain Control % Class A Carries, Trauma and Pain Control % Class A Carries, Trauma and Pain Control % Class A Carries, Trauma and Pain Control % Class A Carries, Trauma and Pain Control % Class A Carries, Trauma and Pain Control % Class A Primary teeth - amalgam % Class A Primary teeth - amalgam % Class A Primary teeth - amalgam % Class A Primary teeth - amalgam % Class A Primary teeth - amalgam % Class A Permanent bicuspid and anterior teeth - amalgam % Class A Permanent bicuspid and anterior teeth - amalgam % Class A Permanent bicuspid and anterior teeth - amalgam % Class A Permanent bicuspid and anterior teeth - amalgam % Class A Permanent bicuspid and anterior teeth - amalgam % Class A Permanent molars % Class A Permanent molars % Class A Permanent molars % Class A Permanent molars % Class A Permanent molars % Class B Other Restorative Services % Class A Retentive pin reinforcement % Class A Retentive Pin reinforcement % Class A Retentive Pin reinforcement

5 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class A Retentive Pin reinforcement % Class A Retentive Pin reinforcement % Class B Stainless Steel Crowns % Class B Stainless Steel Crowns % Class B Stainless Steel Crowns % Class B Stainless Steel Crowns % Class B Stainless Steel Crowns % Class B Stainless Steel Crowns % Class B Stainless Steel Crowns % Class B Stainless Steel Crowns % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations

6 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class A Amalgam and tooth coloured composite resorations % Class B Other Restorative Services % Class B Gold Foil restorations % Class B Gold Foil restorations % Class B Gold Foil restorations % Class B Gold Foil restorations % Class B Gold Foil restorations % Class B Gold Foil restorations % Class B Gold Foil restorations % Class B Metal inlay restorations % Class B Metal inlay restorations % Class B Metal inlay restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Metal inlay restorations % Class B Retentive pins % Class B Retentive pins % Class B Retentive pins % Class B Retentive pins % Class B Retentive pins % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Other Restorative Services % Class B Other Restorative Services % Class B Other Restorative Services % Class B Other Restorative Services % Class B Other Restorative Services % (once every 5 cal yrs) Class B Posts, attachment to endosseous integrated implants % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations

7 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class B Porcelain restorations % Class B Porcelain restorations % Class B Other Restorative Services % Class B Other Restorative Services % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Porcelain restorations % Class B Other Restorative Services % Class B Other Restorative Services % Class B Other Restorative Services % Class B Other Restorative Services % Class B Other Restorative Services % Class B Other Restorative Services % Class B Other Restorative Services % Class B Other Restorative Services % Class A Pulpotmoy, permanent teeth % Class A Pulpotomy, permanent teeth % Class A Pulpotmoy, permanent teeth % Class A Pulpotomy, permanent teeth % Class A Pulpotmoy, permanent teeth % Class A Pulpotomy, permanent teeth % Class A Pulpotomy, permanent teeth % Class A Root Canal Therapy % Class A Root Canal Therapy % Class A Root Canal Therapy % Class A Root Canal Therapy % Class A Root Canal Therapy % Class A Root Canal Therapy % Class A Root Canal Therapy % Class A Apexification % Class A Apexification % Class A Apexification % Class A Apexification % Class A Re-insertion of Dentogenic Media % Class A Re-insertion of Dentogenic Media % Class A Re-insertion of Dentogenic Media % Class A Re-insertion of Dentogenic Media % Class A Apicoectomy % Class A Apicoectomy % Class A Apicoectomy % Class A Apicoectomy % Class A Apicoectomy % Class A Apicoectomy % Class A Apicoectomy % Class A Apicoectomy % Class A Apicoectomy % Class A Apicoectomy % Class A Apicoectomy % Class A Apicoectomy % Class A Apicoectomy

8 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class A Apicoectomy % Class A Apicoectomy % Class A Apicoectomy % Class A Apicoectomy % Class A Apicoectomy % Class A Apicoectomy % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Retrofilling % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Surgical Services % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures

9 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Miscellaneous Endodontic Procedures % Class A Periodontal - Displacement Dressing % Class A Periodontal - Displacement Dressing % Class A Periodontal - Displacement Dressing % Class A Periodontal - Displacement Dressing % Class A Periodontal - Displacement Dressing % Class A Periodontal - Oral Manifestations % Class A Periodontal - Oral Manifestations % Class A Periodontal - Oral Manifestations % Class A Periodontal - Oral Manifestations % Class A Periodontal - Oral Manifestations % Class A Periodontal - Nervous and Muscular Disorders % Class A Periodontal - Nervous and Muscular Disorders % Class A Periodontal - Nervous and Muscular Disorders % Class A Periodontal - Nervous and Muscular Disorders % Class A Periodontal - Nervous and Muscular Disorders % Class A Periodontal - Oral Manifestations % Class A Periodontal - Oral Manifestations % Class A Periodontal - Oral Manifestations % Class A Periodontal - Oral Manifestations % Class A Periodontal - Oral Manifestations % Class A Periodontal - Desensitization % Class A Periodontal - Desensitization % Class A Periodontal - Desensitization % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services

10 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Periodontal - Surgical Services % Class A Post Surgical Treatment % Class A Post Surgical Treatment % Class A Post Surgical Treatment % Class A Post Surgical Treatment % Class A Periodontal abcess/periocoronitis % Class A Periodontal abcess/periocoronitis % Class A Periodontal Splinting % Class A Periodontal Splinting % Class A Periodontal Splinting % Class A Periodontal Splinting % Class A Periodontal Splinting % Class A Periodontal Splinting % Class A Periodontal Splinting % Class A Periodontal Splinting % Class A Occlusion % Class A Occlusion % Class A Occlusion % Class A Occlusion % Class A Occlusion % Class A Occlusion % Class A Root Planing limited to a maximum combined with preventive scaling % Class A Root Planing limited to a maximum combined with preventive scaling % Class A Root Planing limited to a maximum combined with preventive scaling % Class A Root Planing limited to a maximum combined with preventive scaling % Class A Root Planing limited to a maximum combined with preventive scaling % Class A Root Planing limited to a maximum combined with preventive scaling % Class A Root Planing limited to a maximum combined with preventive scaling % Class A Root Planing limited to a maximum combined with preventive scaling % Class A Antimicrobial Agents % Class A Anitmicrobial Agents % Class A Periodontal Appliances % Class A Periodontal Appliances % Class A Maintenance Appliances % Class A Maintenance Appliances

11 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class A Maintenance Appliances % Class A Maintenance Appliances % Class A Maintenance Appliances % Class B Temporomandibular Joint Appliances and maintenance charges to a % Class B Temporomandibular Joint Appliances and maintenance charges to a % Class B Temporomandibular Joint Appliances and maintenance charges to a % Class B Temporomandibular Joint Appliances and maintenance charges to a % Class B Temporomandibular Joint Appliances and maintenance charges to a % Class B Temporomandibular Joint Appliances and maintenance charges to a % Class B Temporomandibular Joint Appliances and maintenance charges to a % Class B Temporomandibular Joint Appliances and maintenance charges to a % Class B Temporomandibular Joint Appliances and maintenance charges to a % Class B Temporomandibular Joint Appliances and maintenance charges to a % (once every 3 cal yrs) Class B Complete maxillary denture % (once every 3 cal yrs) Class B Complete mandibular denture % (once every 3 cal yrs) Class B Complete maxillary and mandibular dentures % (once every 3 cal yrs) Class B Immediate and transitional dentures % (once every 3 cal yrs) Class B Immediate and transitional dentures % (once every 3 cal yrs) Class B Immediate and transitional dentures % (once every 3 cal yrs) Class B Immediate and transitional dentures % (once every 3 cal yrs) Class B Immediate and transitional dentures % (once every 3 cal yrs) Class B Immediate and transitional dentures % (once every 5 cal yrs) Class B Complete dentures, attached to implants % (once every 5 cal yrs) Class B Complete dentures, attached to implants % (once every 5 cal yrs) Class B Complete dentures, attached to implants % (once every 5 cal yrs) Class B Complete dentures, attached to implants % (once every 3 cal yrs) Class B Transitional partial denture % (once every 3 cal yrs) Class B Transitional partial denture % (once every 3 cal yrs) Class B Transitional partial denture % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic

12 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Dentures, partial, acrylic % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % (once every 3 cal yrs) Class B Complete and partial denture % Class B Denture adjustments % Class B Denture adjustments % Class B Denture adjustments % Class B Denture adjustments

13 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class B Denture adjustments % Class B Denture adjustments % Class B Denture adjustments % Class B Denture adjustments % Class B Denture adjustments % Class B Denture adjustments % Class B Denture adjustments % Class B Denture adjustments % Class B Denture repairs/additions % Class B Denture repairs/additions % Class B Denture repairs/additions % Class B Denture repairs/additions % Class B Denture repairs/additions % Class B Denture repairs/additions % Class B Denture repairs/additions % Class B Denture repairs/additions % Class B Denture repairs/additions % Class B Denture repairs/additions % Class B Denture repairs/additions % Class B Denture repairs/additions % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining % Class B Denture rebasing and relining

14 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class B Tissue conditioning % Class B Tissue conditioning % Class B Tissue conditioning % Class B Tissue conditioning % Class B Tissue conditioning % Class B Tissue conditioning % Class B Pontics % Class B Pontics % Class B Pontics % Class B Pontics % Class B Pontics % Class B Pontics % Class B Repairs, Replacements % Class B Repairs, Replacements % Class B Repairs, Replacements % Class B Repairs, Replacements % Class B Removal/Repairs to Fixed Bridge % Class B Removal/Repairs to Fixed Bridge % Class B Removal/Repairs to Fixed Bridge % Class B Removal/Repairs to Fixed Bridge % Class B Removal/Repairs to Fixed Bridge % Class B Removal/Repairs to Fixed Bridge % Class B Removal/Repairs to Fixed Bridge % Class B Removal/Repairs to Fixed Bridge % Class B Porcelain repair % Class B Porcelain repair % Class B Retainers - Crowns % Class B Retainers - Crowns % Class B Retainers - Crowns % Class B Retainers - Crowns % Class B Retainers - Crowns % Class B Retainers - Crowns % (once every 5 cal yrs) Class B Retainers - Attached to implants % (once every 5 cal yrs) Class B Retainers - Attached to implants % Class B Retainers - Crowns % Class B Retainers - Crowns % Class B Retainers - Crowns % (once every 5 cal yrs) Class B Retainers - Attached to implants % (once every 5 cal yrs) Class B Retainers - Attached to implants % Class B Retainers - Crowns % Class B Retainers - Crowns % Class B Retainers - Crowns % Class B Retainers, Metal % Class B Retainers, Metal % Class B Retainers, Metal % Class B Retainers, Metal % Class B Retainers - Crowns % Class B Retainers - Crowns % (once every 5 cal yrs) Class B Retainers - Attached to implants % Class B Splinting % Class B Retentive pins in fixed prosthetics % Class B Retentive pins in fixed prosthetics % Class B Retentive pins in fixed prosthetics

15 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class B Retentive pins in fixed prosthetics % Class B Retentive pins in fixed prosthetics % Class B Provisional coverage % Class B Provisional coverage % (once every 5 cal yrs) Class B Fixed prosthetic framework, attached to endosseous integrated implants % (once every 5 cal yrs) Class B Fixed prosthetic framework, attached to endosseous integrated implants % (once every 5 cal yrs) Class B Fixed prosthetic framework, attached to endosseous integrated implants % (once every 5 cal yrs) Class B Fixed prosthetic framework, attached to endosseous integrated implants % Class A Uncomplicated surgical removal of single erupted tooth % Class A Removal of each additional tooth in same quadrant - same appointment % Class A Removal of erupted tooth (complicated) % Class A Removal of erupted tooth (complicated) % Class A Removal of impacted tooth % Class A Removal of impacted tooth % Class A Removal of impacted tooth % Class A Removal of impacted tooth % Class A Removal of impacted tooth % Class A Removal of impacted tooth % Class A Removal of impacted tooth % Class A Removal of impacted tooth % Class A Removal of residual Roots % Class A Removal of residual Roots % Class A Removal of residual Roots % Class A Removal of residual Roots % Class A Removal of residual Roots % Class A Removal of residual Roots % Class A Surgical Exposure % Class A Surgical Exposure % Class A Surgical Exposure % Class A Surgical Exposure % Class A Surgical Exposure % Class A Surgical Exposure % Class A Surgical Movement % Class A Surgical Movement % Class A Surgical Movement % Class A Surgical Movement % Class A Surgical Movement % Class A Surgical Movement % Class A Surgical Enucleation % Class A Surgical Enucleation % Class A Alveoloplasy % Class A Alveoloplasy % Class A Excision of bone % Class A Excision of bone % Class A Excision of bone % Class A Removal of bone % Class A Gingivoplasty and/or stomatoplasty % Class A Gingivoplasty and/or stomatoplasty

16 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class A Vestibuloplasty % Class A Surgical Excision and drainage % Class A Surgical Excision and drainage % Class A Surgical Excision and drainage % Class A Surgical Excision and drainage % Class A Surgical Excision and drainage % Class A Surgical Excision and drainage % Class A Surgical Excision and drainage % Class A Surgical Excision and drainage % Class A Surgical Excision and drainage % Class A Surgical Excision and drainage % Class A Surgical Excision and drainage % Class A Surgical Excision and drainage % Class A Surgical Excision and drainage % Class A Surgical Excision and drainage % Class A Surgical Excision and drainage % Class A Surgical Excision and drainage % Class A Surgical Incision % Class A Surgical Incision % Class A Surgical Incision % Class A Surgical Incision % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Fractures % Class A Frenectomy % Class A Frenectomy % Class A Frenectomy % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures

17 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical Procedures % Class A Miscellaneous Surgical % (once every 5 cal yrs) Class B Dental Implants % (once every 5 cal yrs) Class B Dental Implants % (once every 5 cal yrs) Class B Dental Implants % (once every 5 cal yrs) Class B Dental Implants % (once every 5 cal yrs) Class B Dental Implants % (once every 5 cal yrs) Class B Dental Implants % (once every 5 cal yrs) Class B Dental Implants % (once every 5 cal yrs) Class B Dental Implants % (once every 5 cal yrs) Class B Dental Implants % (once every 5 cal yrs) Class B Dental Implants % (once every 5 cal yrs) Class B Dental Implants % (once every 5 cal yrs) Class B Dental Implants % (once every 5 cal yrs) Class B Dental Implants % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia

18 PWU REPRESENTED EMPLOYEES - COVERED UNDER THE KINECTRICS DENTAL PLAN % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % Class A Anesthesia % (2 times/person/cal yr) Class A Consultations % (2 times/person/cal yr) Class A Consultations % (2 times/person/cal yr) Class A Consultations % Class A Therapeutic Injections % Class A Therapeutic Injections % Class A In-office laboratory procedures