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News | March 22, 2023

Before Seeing the Dentist, Learn What TRICARE Dental Program Covers

By TRICARE Communications

Whether you’re seeing the dentist for a routine checkup or getting emergency dental care, the TRICARE Dental Program (TDP) covers a wide variety of dental services for active duty family members, as well as National Guard and Reserve members and their family members. If you see a network dentist, you’ll only have to pay a cost-share, or a percentage of the total cost of these services.
 
“Who you are, where you live, and the type of service you need determines your cost-share for covered services with a network dentist,” said Doug Elsesser, program analyst with the Defense Health Agency’s TRICARE Dental Program. “If you see a non-network dentist for services TDP covers, you may pay more out of pocket and need to file a claim for reimbursement.”
 
It’s important to know which services TDP covers before your next dental visit. Here’s a look at some of them.
 
Diagnostic services
These are services to monitor you for oral health issues. TDP covers:
  • Two exams in a consecutive 12-month period by the same provider and one additional exam by a different provider
  • One periodontal evaluation in a consecutive 12-month period per office visit
  • Annual X-rays 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 go to a dental office after regular hours, you may have a cost-share of 20%.
 
Preventive services
These are services that protect your teeth and gums from decay and infection. The TDP covers two routine dental cleanings in a consecutive 12-month period for each enrollee. It also covers a third dental cleaning for pregnant enrollees and those diagnosed with certain chronic medical conditions. To receive this benefit, you must register in My Account. Other routine preventive services include:
  • Fluoride treatments
  • Space maintainers (fully covered for children under the age 19)
  • Space maintainer care
  • Sealants (fully covered for permanent molars, or back teeth, through age 18)
 
There’s no cost-share for preventive dental care when you see a network dentist.
 
Restorative services
TDP covers many restorative services to repair broken or cracked teeth and to protect teeth against cavities. As noted in the TRICARE Dental Program Handbook, you can get coverage for restorative services needed because of tooth decay, tooth fracture, attrition, erosion, abrasion, or congenital or developmental defects. Cosmetic reasons are excluded.
Covered services include:
  • Amalgam (silver) fillings
  • Resin-based composite (tooth-colored) fillings
  • Crowns
  • Veneers (in some instances)
 
There’s no restorative cost-share for command-sponsored enrollees in the TDP OCONUS service area. All other TDP enrollees have a cost-share of 20%.
 
Other services
Other TDP covered services include:
  • Periodontal services
  • Orthodontic services
  • Endodontic services (including root canals)
  • Oral surgery
  • Implants
 
There are some services TDP doesn’t cover. Always talk to your dentist before getting any major dental procedures to make sure you understand whether recommended procedures are covered, and in what amounts.
 
To learn more about services TDP covers, refer to the TRICARE Dental Program Handbook. You can also go to Benefits or log in to My Account to see a list of what’s covered.
 
Looking for more TDP info, including tips for oral health care? Check out the latest TRICARE Dental Program Health Matters Newsletter
 
Would you like the latest TRICARE news sent to you by email? Visit the TRICARE Subscriptions page today, and create your personalized profile to get benefit updates, news, and more.
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