What does limiting the number of payments mean?

Limiting the Number of Payments

There are certain instances when payments for a particular service will be limited.  In most cases, the limitations are based on the similarity of the services.  For example:  You may have received a benefit for a crown in 2019 and your dentist used the dental code 2752 (crown-porcelain fused to noble metal).  If your dentist places a new crown in 2022 using dental code 2792 (crown-full cast noble metal) you will not be eligible for it because of the 5 year frequency limitation.  If you have a dental code 0330 (a panoramic x-ray) done and then have a 0210 (complete series x-rays) done before the 3 year frequency limit is up for the 0330, the 0210 will be denied benefits.  Even though the dental codes are dissimilar – the services are not.  It’s always a good idea to check with the Fund office before the services are done to be sure that the services do not overlap with other services previously performed.