Plan Details

Diagnostic: X-rays and dental exams (children up to age 21)

Preventive: Dental check-ups, fluoride treatments, and wellness services once every 6 months (children up to age 21)

Restorative: Repair of teeth from cavities or trauma, tooth removal, fillings and tooth repairs (children up to age 21)

Endodontic: Medically needed treatment for inside of teeth and tooth roots (children up to age 21)

Periodontics: Special care for treatment of gum disease (children up to age 21)

Prosthodontics: Removable or fixed dentures and partials for missing permanent teeth, allowed once every 5 years (children up to age 21)

Oral and maxillofacial surgery: Specialty care for tooth removal and other medically necessary surgical procedures (children up to age 21)

Orthodontics: Special care for teeth positioning only for severe deformities of the head, mouth and/or teeth; does not cover care for overbites, TMJ, and crooked teeth (children up to age 21)

Emergency care and other services: Special care for traumatic problems to teeth and mouth, mouth guards, help to control bleeding, other emergency-type care, hospital calls (children up to age 21)

Diagnostic: X-rays and dental exams only when getting dentures or partials (age 21+)

Removal prosthodontics: If 6 or fewer teeth, one complete denture set every 8 years, adjusted 6 months later for fit; denture repairs and partial repairs covered every year; the Partial is covered every 8 years; does not cover pulling teeth (age 21+)