Dental Benefits for UCare for Seniors Classic and Select Group Plan Members
UCare understands that dental care is an important part of our members’ overall health.
Members enrolled in the UCare for Seniors Classic plan and select UCare for Seniors Group plans have full coverage for their preventive dental care.* Each plan year, they are eligible to receive:
- Two oral exams.
- Three cleanings.
- One set of x-rays.
- Topical application of fluoride.
All UCare for Seniors Classic members and select Group plan members also are eligible for UCare Comprehensive Dental (PDF), a full dental benefit program available for an additional $21 per month.
More dental codes are covered in 2012!
See the Evidence of Coverage (PDF) for coverage details on the following:
- Onlay - porcelain/ceramic, four or more surfaces (D2644)
- Pulp cap - indirect (excluding final restoration) (D3120)
- Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction and application of medicament (D3220)
- Clinical crown lengthening - hard tissue (D4249)
- Bone replacement graft - first site in quadrant (D4263)
- Subepithelial connective tissue graft procedures, per tooth (D4273)
- Localized delivery of antimicrobial agents via controlled release vehicle into diseased crevicular tissue, per tooth, by report (D4381)
- Surgical placement of implant body: endosteal implant (D6010)
- Prefabricated abutment - includes placement (D6056)
- Custom abutment - includes placement (D6057)
- Abutment supported porcelain fused to metal crown (high noble metal) (D6059)
- Bone replacement graft for ridge preservation - per site (D7953)
- Consultation - diagnostic service provided by dentist or physician other than requesting dentist or physician (D9310)
- Application of desensitizing medicament (D9910)
*Full coverage applies to visits to providers in UCare's network. You may use an out-of-network dentist, but services must be obtained within the United States and territories. Using an out-of-network dentist may cost you more.