All dental plans offer these benefits:
Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
dental program
Covers these services for children until age 21, starting when first
tooth erupts:
Diagnostic: X-rays and dental exams
Preventive: Dental check-ups, fluoride treatments, and wellness services
once every 6 months
Restorative: Repair of teeth from cavities or trauma, tooth removal,
fillings and tooth repairs
Endodontic: Medically needed treatment for inside of teeth and tooth roots
Periodontics: Special care for treatment of gum disease
Prosthodontics: Removable or fixed dentures and partials for missing
permanent teeth, allowed once every 5 years
Oral and maxillofacial surgery: Specialty care for tooth removal and
other medically necessary surgical procedures
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
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
Adult dental program
For adults age 21 and up, services do not include routine dental care or
tooth repairs to natural teeth. These services are covered:
Diagnostic: X-rays and dental exams only when getting dentures or partials
Removal prosthodontics: If 6 or fewer teeth, one complete denture set
every 8 years, adjusted within 6 months for fit; denture repairs and partial
repairs covered every year; partial denture covered every 8 years; does
not cover pulling teeth or surgical removal of teeth
1-800-685-0143 DentaQuest.com
Assessment
1 oral health kit per lifetime for adults 21
and up with floss, toothbrush and paste for
completing online assessment
Extraction (tooth pulled)
Simple teeth pulled with $200 limit for adults
ages 21 and up
Silver diamine fluoride treatment
For children up to age 20, if medically
necessary, to slow or stop tooth decay
Opioid safety
Online course on opioid risks, benefits, and
other choices, with $10 Walmart gift card for
adults 21 and up who complete course within
3 days of tooth pulling; 1 gift per lifetime to use
only for oral health items and healthy foods
Preventive dental care after ER visit
Free cleaning and dental exam for adults ages
21 and up who visit dentist within 7 days of
hospital visit for non-trauma dental care
Sealant
1 drawstring backpack per lifetime with age-
appropriate toothbrush, toothpaste, brushing
chart, and stickers for children ages 6-14 who
get sealants (thin plastic coatings on back teeth
chewing surfaces to protect against cavities)
1-855-702-6262 mcnala.net
Assessment
Cavities risk assessment with dental exam
for ages 21 and up
Extraction (tooth pulled)
Up to 3 teeth pulled when getting dentures,
for ages 21 and up
Silver diamine fluoride treatment
Program for adults with special needs
ages 21 and up to slow or stop tooth decay.
Contact the plan for more information.
Teledentistry
For adult members with special needs,
yearly teledentistry visit not otherwise covered;
in cludes sending x-rays, digital records to
dental specialist
Extra benefits
$10 Amazon.com gift card for children under
age 21 when create account on member portal
and provide email address and phone number
Itty Bitty Baby Teeth book and backpack for
children ages 4-6 at first enrollment
Dental plan comparison chart
Use this chart to compare extra services each plan offers.
This information is as correct and complete as
possible. Extra services may change. Contact the
plans directly to learn more about their services.
Questions?
Call 1-855-229-6848.
LAEB-DP-COMP-E-082
