Benefits for Adults

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

Important to note:

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Care Category
Description
Benefits and Limitations
Diagnostic
Oral examination or screening every calendar year.
Periodic Exam: 1 per year

Problem Focused Exam: 4 times per year

Comprehensive Exam: limited to once 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 year

2. Periapical X-rays: 4 per year

3. Complete Mouth Series or Panoramic X-ray: 1 every 3 years
Preventive
Cleaning, fluoride application.
1 every calendar year per member Fluoride treatment requires prior authorization.
Restorative-Fillings
The treatment of tooth decay by the use of silver and/or white fillings.
Fillings are covered once per two years for the same tooth surface.
Restorative-Crowns
The use of gold, semiprecious, or nonprecious metals and/or porcelain to restore a tooth or teeth which cannot be restored with silver or white restorations.
Covered once per five year. Prior authorization required.
Endodontics
The treatment of the diseases of the blood vessels and the nerve of the tooth. Endodontic treatment often involves root canal procedures.
Once per tooth per Client per lifetime limitation. Certain conditions must be met. Prior authorization is required.
Periodontics
The treatment of the supporting tissues of the teeth, gums, and underlying bone, with either surgical or non-surgical procedures (where applicable).
Not covered.
Prosthetics – Removable
The replacement of missing teeth by the use of a removable appliance.
Denture prosthesis construction is limited to one time per each 7-year period.

Prior authorization required.
Prosthetics –

Adjustments & Relines
The repair or modification of existing dentures so that they can continue to be serviceable.
Limited to once every 2 years, and only 6 months after the initial placement of the denture(s).
Prosthetics – Fixed
The use of gold, semiprecious, or precious metal to replace a missing tooth or teeth. Fixed prosthetics may include bridgework, implants and implant retained crowns and 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. Biopsies, alveoloplasty, bone grafting, facial surgery for trauma and inherited facial conditions, subject to Prior authorization requirements.
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
Requires prior authorization.
Orthodontics
The straightening of teeth for significant dental health reasons.
Not covered for adults.
Athletic Mouth Guard
Mouthguards are worn over the top row of teeth during sports to help prevent an oral injury. They protect against broken teeth, cut lips, and other damage to the mouth.
Not covered for adults.
Occlusal “Night” Guards
A removable acrylic appliance intended to relieve temporomandibular joint pain and other effects of grinding the teeth (bruxism). Usually worn at night to prevent grinding during sleep.
Prior Authorization required for members with severe clenching or tooth grinding habits. May be used to treat temporomandibular joint (TMJ) problems.
Deep Sedation/General Anesthesia
Covered for general dental procedures and tooth extractions in children under the age of 9 OR for children under the age of 21 with behavioral related conditions such as autism, cerebral palsy, intellectual delays.
Covered in certain situations.
Inhalation Sedation
Nitrous oxide. Covered for adults over the age of 21 with behavioral related conditions such as autism, cerebral palsy, intellectual delays and have a diagnosis of 318.0 or greater.
Not covered for adults without a severe or profound developmental delay.