DentaQuest® Personal Dental Plan

PPO plans are available in the following states: AZ, GA, IL, MO, OH, & TX with out of network coverage
EPO Plans are sold in FL, IN, IL, PA, TN & VA with no out of network coverage

Coverage Summary

Coverage type Calendar year deductible DentaQuest will pay
 
Diagnostic and preventive services None 100%
Restorative and other basic services Not a covered service Not a covered benefit
Complex dental services Not a covered service Not a covered benefit
Orthodontics (under age 19) Not a covered service Not a covered benefit

What is the waiting period for services? There are never waiting periods for Preventative or Diagnosis services.
 
Is there out of network coverage?
In AZ, GA, IL, MO, OH, & TX: YES, DentaQuest will pay the same percentage for covered services received in and out of network. But if the member chooses to see a non-contracting dentist (out of network), they will be responsible for the difference between the plan’s allowable charges (what contracting dentists receive for payment from DentaQuest®) and the dentist’s usual and customary fees (what the dentist charges cash-paying patients). This means the member saves more by receiving care from a contracting dentist.
 
In FL, IN, LA, TN and VA: NO, If a member visits a dentist who is not in our network, they will be responsible for the entire cost of the services you receive. Members may only receive covered benefits from a non-participating dentist in the event of an emergency dental condition.
 
What are the annual limits and maximums? For covered individuals, the benefits are not limited to a maximum dollar payment for covered services shown in the schedule of benefits.
 
Are Dependents Covered? Yes, Dependent children are covered up to and including age 26.


 
Category / Procedure Benefit frequencies DentaQuest will pay
 
Diagnostic
Initial oral exam Once per dentist per 60 months 100%
Periodic oral exam Twice per plan year 100%
Full mouth X-rays Once every 60 months 100%
Bitewing X-rays Twice per plan year 100%
Single tooth X-rays As needed 100%

Preventive
Routine cleaning Twice per plan year 100%
Fluoride varnish application Children under 19 – Twice per plan year 100%
Topical fluoride treatment Children under 19 – Twice per plan year 100%
Space Maintainers Only for children under age 14 and not for the replacement of primary or permanent front teeth 100%
Sealants Sealants on unrestored permanent molars, once per tooth for children under 16. 100%