Arthrocentesis
Arthroplasty
Arthroscopy - surgical
Arthrotomy
Bridge Pontics
Bridge Retainers
Condylectomy
Coronoidectomy
Dental x-rays, unless
required as a result of injury incurred while detainee is in the
custody of the USMS, or for diagnostic purposes in the presence of
pain and suffering
Dental fillings, unless
required as a result of injury incurred while detainee is in the
custody of the USMS, or to relieve pain and suffering
Dental crowns
Endodontic endosseous
implants
Fluoride treatments
Gold Foil Restorations
Intra-oral soft tissue
grafts
Joint reconstruction
Oral surgical implant
Orthodontia -
Initiation, replacement, adjustment, or maintenance
of braces. (Removal of braces is covered if clinically indicated)
Orthognathic surgery
Osteoplasty for
orthognathic deformities
Osteotomy of ramus, with
or without bone graft
Osteotomy of the body of
the mandible
Osteotomy-segmented or
subapical-per sextant or quadrant
Partial ostectomy
Periodontal treatment,
including surgical procedures
Radical resection of
mandible with bone graft
Retainers
Root canals when any of
the following conditions are present:
the tooth is a third
molar; inadequate oral hygiene; the tooth is periodontally
compromised; high caries rate; the tooth requires extensive
restoration; missing teeth in the same arch which will be
replaced with a removable prosthesis; opposing tooth is missing;
other teeth in the same arch are of questionable prognosis; or
the tooth is not essential to maintain the integrity of the
arch.
Routine dental care,
other than to relieve pain and suffering
Routine dental hygiene
care, unless the detainee has been in the uninterrupted custody of
the USMS for greater than 12 months.
Skin grafts
Surgical discectomy;
with or without implant
Synovectomy
Transseptal fiberotomy
Treatment for
temporomandibular joint dysfunction and disorders,
including surgery and appliances
Upper or lower dentures,
except in cases in which the detainee was taken into custody with
dentures, and they are broken while he or she is in custody
