Benefits Coverage
Please see the expandable menus below for what dental services are covered.
All covered services are free as long as your provider says you need the services. Look at the “Service” column to see how many times you can get each service for free. Look at the “How to access” column to see if you need to get a referral or preapproval for the service.
A star (*) in the benefit chart means a service may be covered beyond the limits listed for members under 21, if medically necessary and appropriate.
Care Coordination Services
Care coordinators learn about your needs, make sure your providers talk to each other, and help with supplies and additional services. No limit, frequency and intensity based on situation/need.
How to Access:
No referral or preapproval is needed to access this service.
Who Is Eligible For Care Coordination Services?
All members have access to this service.
Emergency and Urgent Dental Care
Examples: extreme pain or infection, bleeding or swelling, injuries to teeth or gums. No limits. Learn more about what to do if you are experiencing an emergent or urgent dental condition.
How to Access:
No referral or preapproval is needed to access this service.
Who Is Eligible For Care Coordination Services?
All members have access to this service.
Oral Exams*
Dental providers check the health of your teeth and gums, and perform an oral cancer screening.
Members under 19 years old: Twice a year. All other members: Once a year, more covered if medically necessary and dentally appropriate.
How to Access:
No referral or preapproval if you see your primary care dentist.
Who Is Eligible For Care Coordination Services?
All members have access to this service.
Oral Cleanings*
Dental hygienists clean your teeth and gums. Members under 19: Twice a year. All other members: Once a year.
How to Access:
No referral or preapproval if you see your primary care dentist.
Who Is Eligible For Care Coordination Services?
All members have access to this service.
Fluoride Varnish*
Dental providers apply a thin coating of fluoride on your teeth to protect them. Members under 19: Twice a year. Members 19 and older: Once a year. Any high-risk members: Up to four times per year.
How to Access:
No referral or preapproval if you see your primary care dentist.
Who Is Eligible For Care Coordination Services?
All members have access to this service.
Fillings
Silver or tooth-colored material used to fill cavities. No limits.
How to Access:
No referral or preapproval if you see your primary care dentist.
Who Is Eligible For Care Coordination Services?
All members have access to this service.
Partial or Complete Dentures
Dentures are false teeth. Partial dentures fill in spaces from missing teeth. Complete dentures are used when you are missing all of your upper and/or lower teeth. Partial: Once every five years. Complete dentures: Once every 10 years. Only available for qualifying members or incidents, call your dental health plan for details.
How to Access:
Preapproval needed. Referral needed if not seeing your primary care dentist.
Who Is Eligible For Care Coordination Services?
This service is available to members 16 years old or older.
Crowns*
Crowns are caps for damaged teeth. Benefits vary by type of crown, specific teeth requiring care, age, and pregnancy status. Contact your dental health plan.
How to Access:
Preapproval needed. Referral needed if not seeing your primary care dentist.
Who Is Eligible For Care Coordination Services?
This service is available to members who are pregnant or under 21 years old.
Extractions
Pulling a tooth that needs to be removed to keep you healthy. Authorization may be required for wisdom teeth; may also be required for other extractions.
How to Access:
Preapproval needed. Referral needed if not seeing your primary care dentist.
Who Is Eligible For Care Coordination Services?
All members have access to this service.
Root Canal Therapy*
A root canal is a procedure that repairs decayed or infected teeth. Under 21: Not covered on third molars (wisdom teeth). Pregnant members: Covered on first molars. All other members: Only on front teeth and pre-molars.
How to Access:
Preapproval needed. Referral needed if not seeing your primary care dentist.
Who Is Eligible For Care Coordination Services?
All members have access to this service.
Orthodontics
In cases such as cleft lip and palate, or when speech, chewing and other functions are affected. You must have approval from your dentist and have no cavities or gum disease.
How to Access:
Preapproval needed.
Who Is Eligible For Care Coordination Services?
Members under 21 years old have access to this service.
Non-Emergent Medical Transportation (NEMT) Services
These services include mileage reimbursement, transit passes, and rides to your health care appointments.
How to Access:
Preapproval needed.
Who Is Eligible For Care Coordination Services?
All members have access to this service.
The information above is not a full list of services that need preapproval or referral. If you have questions, please call Advantage Dental Services at 866-268-9631 (TTY 711).
How Long It Takes To Get Care
We work with providers to make sure that you will be seen, treated or referred.
Oral and Dental Care For Children and Non-Pregnant People
Below are time frames for how long children and non-pregnant people can expect to wait to receive oral health care:
- Regular oral health appointments — Within 8 weeks unless there is a clinical reason to wait longer.
- Urgent oral care — Within 2 weeks.
- Dental emergency services — Seen or treated within 24 hours.
Oral and Dental Care For Pregnant People
Below are time frames for how long pregnant people can expect to wait to receive oral health care:
- Regular oral health appointments — Within 4 weeks unless there is a clinical reason to wait longer.
- Urgent oral care — Within 1 week.
- Dental emergency services — Seen or treated within 24 hours.
