Benefits for Adults

Your Dental Plan with the Connecticut Dental Health Partnership offers coverage for the following benefits:

Important to note:

HUSKY Health covers certain MEDICALLY necessary dental services. Adults are ages 21 and older. Covered CT, for adults ages 21 - 64.
Not all dental procedures are covered benefits, and certain covered dental services require prior authorization by your dentist.
Covered services are provided at dental providers in the CTDHP network which is part of the HUSKY Health network. You will have to pay for services if the service is provided by a dentist that does not participate in the CTDHP network, or if you choose to have a service that is not included in the HUSKY Health plan.
If you wish to speak to a member services representative, please call the Connecticut Dental Health Partnership (CTDHP) toll free 1-855-CT DENTAL (1-855-283-3682). We are available Monday through Friday, from 8:00 a.m. to 5:00 p.m.

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Care Category	Description	Benefits and Limitations
Diagnostic	Oral examination or screening.	Periodic Exam: 1 per calendar year Problem Focused Exam: 4 per calendar year Comprehensive Exam: Limited to 1 per lifetime
X-Rays	Complete mouth X-rays, periapical X-rays, bitewing X-rays, Occlusal X- rays and panoramic X-rays.	1. Bitewing X-ray: 1 per calendar year 2. Periapical X-rays: 4 per calendar year 3. Complete Mouth Series or Panoramic X-ray: 1 every 3 years
Preventive	Services that prevent oral disease. Cleanings, fluoride, sealants, space maintainers	Cleanings: 1 per calendar year Fluoride treatment: 1 every per calendar year Space maintainers: Frequency limits apply
Restorative-Fillings	Composite fillings, amalgam fillings	Fillings: covered once every two years per tooth per surface
Restorative-Crowns	Stainless steel crowns, full cast predominantly base metal crowns, porcelain fused to predominantly base metal crowns	Covered once per five year. Prior authorization required.
Endodontic (Root Canal)	Root canals and pulp therapy, pulpotomy, apicoectomy	Once per tooth per lifetime limitation Requires prior authorization
Periodontics	Gum disease treatment scaling and root planing, periodontal maintenance, gingivectomy	Requires prior authorization Maintenance limits, and frequency limits apply
Prosthetics – Removable	Dentures and removable appliances. Complete dentures, partial dentures	Limited to one time per each 7-year period Requires prior authorization
Prosthetics – Adjustments & Relines	Repairs, relines	Limited to once every 2 years, Allowed 6 months after the initial placement of the denture(s) Requires prior authorization
Prosthetics – Fixed	Bridges and fixed partial dentures, implants and implant retained crowns and fixed dentures	Not covered
Extractions	The extraction, either simple or surgical, of either a single tooth or multiple teeth.	May be covered for all permanent, baby and extra teeth.
Wisdom Tooth Removal and Impactions	The surgical removal of fully erupted teeth when medically necessary or teeth partially or fully covered by gum tissue or bone.	Prior authorization required.
Oral Surgery	Biopsies, alveoloplasty, bone grafting, facial surgery for trauma and inherited facial conditions, subject to Prior authorization requirements.	Prior authorization Required
Orthodontics	Tooth/jaw alignment treatment. Comprehensive ortho, limited ortho, replacement of orthodontic retainers	Not covered for adults
Athletic Mouth Guard	Athletic Mouth Guard	Not covered for adults.
Occlusal “Night” Guards	Occlusal “Night” Guards	Prior Authorization required Limited to cases of medical necessity
Deep Sedation/General Anesthesia	Deep Sedation, General Anesthesia palliative care, case management. Miscellaneous services	• Covered for members under the age of 9 (prior to 9th birthday) • Covered members with behavioral related conditions such as autism, cerebral palsy, intellectual delays • Covered when multiple oral surgical procedures are performed at the same visit • Covered in cases where 5 or more extractions are performed or for removal of 3rd molars • Requires prior authorization for some specialties
Inhalation Sedation	Analgesia, Anxiolysis, Inhalation of Nitrous Oxide “Laughing Gas”	• Covered for members under the age of 9 (prior to 9th birthday) • Covered members with behavioral related conditions such as autism, cerebral palsy, intellectual delays • Covered when multiple oral surgical procedures are performed at the same visit • Covered in cases where 5 or more extractions are performed or for removal of 3rd molars • Requires prior authorization for some specialties