Your Dental Benefits

It is important that you get regular dental exams and cleanings. This will help with your overall health and can help prevent future dental problems. If you have tooth pain, call your dentist right away. Your dentist will work with you to meet your oral health care needs. They will help you decide what to do next.

Some types of services require your dentist to contact your dental plan before you receive the service. This is called prior authorization. Your dentist will let you know when the service has been authorized. Some examples of services that may need prior authorization are crowns, root canals, extractions, partials or dentures.

Explore your coverage

Here are some of your covered dental benefits as a member of IHN-CCO. These services are covered when given by an in-network provider. If you think you need a service that is not listed below, you or your provider should contact your dental plan before you get the service. If you cannot reach your dental plan, contact us.

The services listed below are subject to the Prioritized List of Health Services. Benefits are subject to change.

Service	Your Cost*	Approval/Referral	Limits to Care
Basic restorative care such as a filling	$0	Not required	No limit
Dentures	$0	Approval required	Full: Once every 10 years if dentally appropriate Partial: Once every 5 years if dentally appropriate
Emergency dental care	$0	Not required	No limit
Exams, cleanings, and x-rays	$0	Not required	Once annual exam for adults; two for children under 18. Follow-up care allowed. You may have extra dental benefits during your pregnancy. Call your assigned dental plan for details.
Extractions (removing teeth)	$0	Approval required for wisdom teeth	Wisdom teeth are a limited benefit not covered for orthodontics. No limit for other services
Periodontal maintenance	$0	Not required	Covered once every six months. You may have extra dental benefits during your pregnancy. Call your assigned dental plan for details.
Specialist care	$0	Referral required	Approval may be required for certain services. Contact your assigned dental plan for details.

*This cost only applies when services are given by an in-network provider. Any services with an out-of-network provider must have prior authorization or approval, unless it is an emergency. If you do not get approval, you may have to pay.

The information on this page is a summary of your IHN-CCO benefits. For a full description of the benefits and services available to you, read your IHN-CCO Member Handbook.

2020 Member Handbook

Prioritized List of Health Services

Non-covered dental services

Unfortunately, IHN-CCO and Oregon Health Plan cannot cover everything. We try to cover the most important services to treat common dental problems and keep you healthy. Some examples of non-covered dental services are:

Desensitization (to reduce root sensitivity)
Implant and implant services
Mastique or veneer procedure
Orthodontia (except when it is treatment for cleft palate or cleft lip)
Overhang removal
Procedures, appliances or restorations solely for looks and cosmetic purposes
Temporomandibular joint (TMJ) dysfunction treatment
Teeth bleaching

If you have any questions about non-covered services, please contact your assigned dental plan.

Getting care

You need to choose a clinic or dental office as your primary care dentist. Your dentist will arrange all of your dental care. Your dentist will also send you to a specialist if you need to go. Please call your dental plan’s customer service department for your dentist’s name, phone number, address and office hours. It is important to choose a provider office near your home.

As a member of IHN-CCO, you have the right to choose your primary care dentist and dental plan. IHN-CCO does not limit the dentist or dental plan you choose, if they are in-network and accepting new patients. If you wish to change your dentist, please contact your dental plan. If you do not know which dental plan you are assigned to, please contact Customer Service for help.

When you call your dental plan, be sure to let them know if you have any medical conditions that may affect your oral health, like pregnancy or diabetes.

Urgent dental care

Always call your primary care dentist’s office first about any dental problem. Someone will be able to help you day and night, even on weekends and holidays. If you can’t reach your dentist’s office about an urgent problem, or they can’t see you soon enough, you can go to the urgent care or walk-in clinics without an appointment. If you don’t know how urgent the problem is, call your dentist. Prior approval is not required for urgent care services anywhere in the United States.

Some examples of urgent dental situations are:

Severe tooth pain or infection
Swollen gums
A lost filling
Broken tooth

Dental health emergency

A dental health emergency includes severe tooth pain, a tooth that has been knocked out, severe swelling or infection of the gums around the tooth, and a serious abscess. A dental health emergency is dental care requiring treatment within 2 days or sooner. For a dental health emergency, please call your primary care dentist. If your dentist cannot be reached, call your dental plan and a person will help you with your emergency. If you cannot reach your dentist or dental plan, call 911 or go to a hospital emergency room, or another place that can treat dental emergencies. Dental emergencies do not require prior approval anywhere in the United States. A ride to the hospital in an ambulance is covered without prior approval if it is an emergency.

Forms and downloads

Here are a few forms you or your provider may need. These forms relate to your dental coverage:

Authorized Representative Form 64.19 KB	You have the right to choose an Authorized Representative. This person has your permission to discuss your health information with IHN-CCO.
Choose Dental Plan Card 66.02 KB	Choose or change your dental plan by filling out this card and mailing it to us.
Prior Authorization Request Form 23.95 KB	Your primary care dentist will use this form to request an authorization for dental services.

Your Dental Benefits

Explore your coverage

Non-covered dental services

Getting care

Dental plans

Advantage Dental Services

Capitol Dental Care

Moda/Oregon Dental Services

Willamette Dental Group

Urgent dental care

Dental health emergency

Forms and downloads

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