DentaQuest® Personal Dental Plan Comprehensive Plus With Ortho 1500

Plans with in- and out-of-network coverage are available in the following states: GA (coming soon to PA, TN, TX and VA) with access to both the DentaQuest and DenteMax commercial networks.

Coverage Summary

Coverage type Calendar year deductible DentaQuest will pay
 
Diagnostic and preventive services None 100%
Restorative and other basic services $50 per covered individual / $150 per family  80%
Complex dental services $50 per covered individual / $150 per family 50%
Orthodontics $50 per covered individual / $150 per family 50%

Waiting Period: There are no waiting periods for any services except orthodontia (12-month waiting period).

Is there out-of-network coverage?
In GA (coming soon to PA, TN, TX and VA): 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.
 
What are the annual limits and maximums?
The total benefits are limited to a maximum of $1,500 per member for each plan year.
Orthodontic services have a separate lifetime benefit maximum of $1,500 per member.

Do deductibles apply to diagnostic and preventive services?
No, the deductible only applies to restorative, basic and complex dental services. 

 
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%
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%

Restorative
Silver fillings Once every two years per surface per tooth 80%
White fillings (Back teeth) Once every two years per surface per tooth 80%
Stainless steel crowns on baby teeth Once every 24 months per tooth 80%
Rebase or reline dentures Once every 36 months 80%
Recementing fixed bridges Once per lifetime 80%

Anesthesia
General anesthesia Allowed with covered surgical services only 80%
 
Endodontics
Root canal treatment Once per tooth 80%
Vital pulpotomy Limited to deciduous teeth 80%
     
Periodontics
Periodontal cleaning Must meet periodontal guidelines 80%
Scaling and root planing Once per quadrant per 24 months 80%
Periodontal surgery Once per quadrant per 36 months 80%

Oral Surgery
Simple extractions Once per tooth 80%
Surgical extractions Once per tooth 80%

Emergency Dental Care
Minor treatment - pain relief Three occurrences in twelve months 80%

Complex
Crown and onlays Once per tooth every five years 50%
Replacement crowns Once every 60 months per tooth 50%
Implants Once per tooth per 60 months  50%

Dentures and Bridges
Complete or partial dentures Once every 60 months 50%
Fixed bridges Once every 60 months 50%
Replacement dentures or fixed bridges Once every 60 months  50%
Adding teeth to existing dentures Once per tooth 50%

Orthodontia

Once per lifetime

50%