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% |