What Services Does the Aetna Dental Maintenance Organization Cover?


Quick Answer

Aetna's Dental Maintenance Organization's standard plan typically covers four dental exams, two teeth cleanings and one set of bitewing x-rays per calendar year and full mouth x-rays once every three years. One fluoride treatment per calendar year and one sealant application per tooth every three years are additional services for children under the age of 16 usually included in the standard DMO plan. Other typically covered services include sealants for permanent molars and scaling and root planning every three years.

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Full Answer

Standard plans also cover two periodontal maintenance visits each calendar year following periodontal surgery, space maintainers for premature loss of primary teeth and dentures, crowns and replacement of inlays and onlays for those five years and older. While Aetna allows coverage for all dental care and services, including oral surgery, replacement prosthetics, orthodontics and composite fillings, covered services vary by plan. A summary of benefits document, available from the employer's benefits or human resources department, identifies the specific dental services available under a specific plan.

Those insured through Aetna's DMO must select a primary care dentist from a list of participating dentists supplied by Aetna. The primary care dentist makes referrals to specialists, including pediatric dentists, as needed. Should a patient require emergency dental care and the primary care dentist is not available, the patient must contact Aetna for prior approval.

Those insured through Aetna's DMO pay either a set dollar amount or a percentage of covered expenses at the time of service, depending on their specific plan, with no deductibles or annual maximums.

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