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News | Sept. 23, 2021

Knowing What’s What: Comparing TRICARE Dental Program Covered Services

By TRICARE Communications

From routine dental cleanings to oral surgery, the TRICARE Dental Program (TDP) gives you access to a wide range of covered dental services. These services are placed into categories, and it’s important to know the differences between them so you’re aware of when and how much you need to pay for care.
 
“Some of the main TDP covered services include diagnostic, preventive, and orthodontic care,” said Doug Elsesser, program analyst with the Defense Health Agency’s TRICARE Dental Program. “Who you are, where you live, and the type of service you need determines your cost-share.”
 
A cost-share is a percentage of the total cost of a covered dental service that you pay. You won’t have to pay more than your cost-share when you see a network dentist. Here’s a look at some of the different types of TDP covered services.
 
Preventive Care
Preventive dental care is used to protect your gums and teeth from decay and infection. The TDP covers two routine dental cleanings in a consecutive 12-month period for each enrollee. And it covers a third dental cleaning for pregnant enrollees, as mentioned in the TRICARE Dental Program Handbook. You’ll find many other routine services in this category, such as:
  • Fluoride treatments
  • Space maintainers (fully covered for children under the age 19)
  • Space maintainer care
  • Sealants (fully covered for permanent molars through age 18) 
There’s no cost-share for preventive dental care. That means you won’t have to pay anything out of pocket.
 
Diagnostic Care
Diagnostic dental care involves exams to monitor you for oral health issues. The TDP covers two exams in a consecutive 12-month period by the same provider and an additional exam by a different provider. This category also covers annual X-rays and one periodontal evaluation in a consecutive 12-month period per office visit. There’s no cost-share for diagnostic services from your regular dentist. If you receive a diagnostic consultation by an additional dentist or visit a dental office after regular hours, you may have a cost-share of 20%.
 
Basic Restorative
Dentists use restoratives to repair broken or cracked teeth, and to protect against cavities. These services include:
  • Fillings
  • Resin-based composite crowns
  • Prefabricated crowns
To see limitations and learn more details, download the TRICARE Dental Program Handbook. Keep in mind, there’s no restorative cost-share for command-sponsored enrollees in the OCONUS service area. All other enrollees have a cost-share of 20%.
 
Orthodontics
This category includes braces, retainers, and other orthodontic services for eligible TDP enrollees. Those eligible include:
  • National Guard and Reserve sponsors under age 23
  • Spouses of active duty or National Guard and Reserve sponsors under age 23
  • Children under age 21, or under age 23 if enrolled full time at an accredited college or university 
Remember, if you see a non-network dentist for any of the above services, you may pay more out of pocket and need to file a claim for reimbursement. Some dental care counts towards your TDP maximum benefit. This is the limit on how much the TDP will pay per person.
 
For a list of covered services and their respective cost-shares, visit the “What’s Covered” section of the TDP website. You can also refer to the TRICARE Dental Program Handbook for more details.
 
If you’re looking to catch up on the latest dental news, make sure you check out issue 3 of the TRICARE Dental Program Health Matters Newsletter. Download it from the TRICARE Publications page.
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