Dental Health Benefits

Exams, cleanings, x-rays

  • Referral: No referral required
  • Limits: One annual exam for adults; two annual exams for kids under 18; follow-up care allowed.

Basic restorative care (fillings)

  • Referral: No referral required
  • Limits: No limit

Stainless steel crowns for molars (back teeth)

  • Referral: Yes, approval (or authorization) required

Extractions (removing teeth)

  • Referral: Authorization required for wisdom teeth
    Authorization not required for other teeth
  • Limits: Wisdom teeth are a limited benefit. Not covered for orthodontics
    No limit for other services

Complex restorative care (dentures)

  • Referral: Authorization required
  • Limits: Only available for qualifying members or incidents. Call your dental health plan for details.