Your ZIP Code spans multiple counties.
2021 CarePartners of Connecticut Dental Option
About the plan
The CarePartners of Connecticut Dental Option is provided by Dominion National, a leading administrator of dental benefits. The plan includes access to thousands of dentists across the region. Our CareAdvantage Prime and CareAdvantage Premier plans have limited embedded preventive and restorative coverage, but this plan gives you the comprehensive coverage you need. No waiting periods!
If you are a current member and would like to add the 2021 CarePartners of Connecticut Dental Option to your plan, call 1-844-267-1361 (TTY: 711). (If you signed up for the CarePartners of Connecticut Dental Option in 2020, your coverage will automatically renew.)
Essentials
Premium
Annual Deductible
Diagnostic Services
Comprehensive oral exam
Including the initial dental history and charting of teeth. Once every 36 months.Periodic oral evaluation
Two per year.Emergency oral evaluation problem focused exams
Once every 12 months.Intra-oral X-ray image of the entire mouth
Panoramic image. Once every 60 months.Intra-oral X-ray image of the entire mouth
Full mouth series. Once every 60 months.Intra-oral bitewing X-ray images
X-rays of the crowns of the teeth when oral conditions indicate need. Two per year.Single tooth X-ray images
As needed.Comprehensive oral exam
Including the initial dental history and charting of teeth. Once every 36 months.Periodic oral evaluation
Two per year.Emergency oral evaluation problem focused exams
Once every 12 months.Intra-oral X-ray image of the entire mouth
Panoramic image. Once every 60 months.Intra-oral X-ray image of the entire mouth
Full mouth series. Once every 60 months.Intra-oral bitewing X-ray images
X-rays of the crowns of the teeth when oral conditions indicate need. Two per year.Single tooth X-ray images
As needed.Preventive Services
Prophylaxis (routine cleaning, scaling, and polishing of teeth)
Two per year.Periodontal cleaning
Once every 6 months following active periodontal therapy, not to be combined with regular cleanings.Prophylaxis (routine cleaning, scaling, and polishing of teeth)
Two per year.Periodontal cleaning
Once every 6 months following active periodontal therapy, not to be combined with regular cleanings.Restorative Services
Silver fillings and white fillings (front teeth)
Once every 24 months per surface per tooth.White fillings (back teeth)
Covered only for single surfaces. Once every 24 months per surface, per tooth; multi-surfaces will be processed as a silver filling, and the patient is responsible up to the contracted fee.Inlays
Once per tooth per 84 months.Protective restorations
Once per tooth.Silver fillings and white fillings (front teeth)
Once every 24 months per surface per tooth.White fillings (back teeth)
Covered only for single surfaces. Once every 24 months per surface, per tooth; multi-surfaces will be processed as a silver filling, and the patient is responsible up to the contracted fee.Inlays
Once per tooth per 84 months.Protective restorations
Once per tooth.Oral Surgery
Simple extractions
Once per tooth.Surgical extractions
Once per tooth.Simple extractions
Once per tooth.Surgical extractions
Once per tooth.Periodontics
Periodontal surgery
One surgical procedure per lifetime; gingivectomy or gingivoplasty and osseous surgery covered as needed.Scaling and root planing
Once in 24 months, per quadrant.Bone grafts and guided tissue regeneration
Once per lifetime.Periodontal surgery
One surgical procedure per lifetime; gingivectomy or gingivoplasty and osseous surgery covered as needed.Scaling and root planing
Once in 24 months, per quadrant.Bone grafts and guided tissue regeneration
Once per lifetime.Endodontics
Root canal treatment
Once per tooth per lifetime.Retreatment root canal therapy
Once per tooth per lifetime after 24 months of initial root canal therapy.Apicoectomy
Covered as needed.Root canal treatment
Once per tooth per lifetime.Retreatment root canal therapy
Once per tooth per lifetime after 24 months of initial root canal therapy.Apicoectomy
Covered as needed.Prosthetic Maintenance
Bridge or denture repair
Once every 24 months per bridge or denture.Tissue conditioning
One treatment per denture every 84 months.Adding teeth to existing partial or full dentures
Once per tooth, per denture, per 24 months.Rebase or reline of dentures
Once per denture every 24 months.Recement of crowns and onlays
Once per tooth per 12 months.Bridge or denture repair
Once every 24 months per bridge or denture.Tissue conditioning
One treatment per denture every 84 months.Adding teeth to existing partial or full dentures
Once per tooth, per denture, per 24 months.Rebase or reline of dentures
Once per denture every 24 months.Recement of crowns and onlays
Once per tooth per 12 months.Adjunctive Services
Minor treatment for pain relief
Only if no services other than exam and X-rays were performed on the same date of service.Local anesthesia and inhalation of nitrous oxide/analgesia, anxiolysis
Local Anesthesia and inhalation of nitrous oxide/analgesia, anxiolysis are provided in conjunction with covered oral surgery or periodontal surgery and are integral to the primary treatment.Minor treatment for pain relief
Only if no services other than exam and X-rays were performed on the same date of service.Local anesthesia and inhalation of nitrous oxide/analgesia, anxiolysis
Local Anesthesia and inhalation of nitrous oxide/analgesia, anxiolysis are provided in conjunction with covered oral surgery or periodontal surgery and are integral to the primary treatment.Prosthodontics
Dentures
Complete or partial dentures; one per arch within 84 months.Fixed bridges
Once per 84 months.Temporary partial dentures
Once per 84 months.Dentures
Complete or partial dentures; one per arch within 84 months.Fixed bridges
Once per 84 months.Temporary partial dentures
Once per 84 months.Major Restorative
Crowns and onlays-initial placement
When teeth cannot be restored with regular fillings due to fracture or decay. Once within 84 months per tooth.Post and core or crown buildup
When needed to retain a crown on a tooth with excessive breakdown due to caries and/or fractures. Once per tooth every 84 months.Crowns and onlays-initial placement
When teeth cannot be restored with regular fillings due to fracture or decay. Once within 84 months per tooth.Post and core or crown buildup
When needed to retain a crown on a tooth with excessive breakdown due to caries and/or fractures. Once per tooth every 84 months.Interested in adding the CarePartners of Connecticut Dental Option to your plan?
It's easy to add the CarePartners of Connecticut Dental Option to your plan. Just call 1-844-267-1361 (TTY: 711) and one of our Licensed Medicare Agents can answer any questions you have and enroll you in just a few minutes.
The CarePartners of Connecticut Dental Option is in addition to your medical coverage with CarePartners of Connecticut. It is not automatically included. To add the Dental Option to your plan, call 1-844-267-1361. The plan is administered by Dominion Dental Services, Inc., which operates under the trade name Dominion National. Services must be performed by providers in the Dominion PPO Network. Please refer to your Evidence of Coverage for more information.