TRICARE Benefits and Coverage | What's Covered? (2024)

The following chart provides an overview of the TDP covered services and their respective cost-shares. TRICARE Dental benefits are the same for the CONUS service area as they are for the OCONUS service area.

Please note: The TDP provides selected services including endodontic, periodontic, and oral surgery at a reduced cost-share for enrollees who are grades E-1 to E-4. For more detailed information about the TDP covered services, see the TDP Handbook and the TDP Handbook supplement which contains covered codes and limitations.

Maximum Benefits

Maximum	Amount
Annual Benefit Maximum	$1,500 per enrollee
Orthodontic Lifetime Maximum (See age limitations in Orthodontics Section below)	$1,750 per enrollee
Dental Accident Coverage Annual Maximum	$1,200 per enrollee

Your Cost-Share

Covered Services	CONUS Service Area		OCONUS Service Area
	Pay Grades E-1 - E-4	Pay Grades E-5 and above	Command-Sponsored Beneficiaries¹
Diagnostic Exams - 2 in a consecutive 12-month period by same provider. Additional exam covered by different provider Periodontal evaluation - 1 in a consecutive 12-month period, per office Full mouth x-ray (complete series or panoramic x-ray) - 1 in 36 months Bitewing X-rays - 1 in a consecutive 12-month period	0%	0%	0%
Preventive² Cleanings - 2 in a consecutive 12-month period. 3rd cleaning is allowed for pregnant patients and patients diagnosed with diabetes, coronary artery disease (heart), cerebral vascular disease (stroke), rheumatoid arthritis, lupus, oral cancer and recipients of an organ transplant. Topical fluoride treatments – 2 in a consecutive 12-month period Space maintainers under age 19	0%	0%	0%
Sealants Sealants on permanent molars through age 18	0%	0%	0%
Consultation/Office Visit Diagnostic consultation by additional dentist Office visit after regular hours	20%	20%	0%
Post-Surgical Services	20%	20%	0%
Basic Restorative Fillings (amalgam and resin) 1 in a consecutive 12 month period Resin-based composite crowns on anterior (front) teeth – 1 in a consecutive 12-month period. Prefabricated resin crowns – once per tooth per lifetime on anterior primary teeth, anterior permanent teeth through age 14 or as result of accidental injury. Prefabricated stainless steel crowns with resin windows – once per tooth per lifetime. On primary anterior and premolar teeth to any age, on permanent anterior and premolar teeth through age 14.	20%	20%	0%
Endodontic	30%	40%	0%
Periodontic Surgical and non-surgical periodontic services Additional benefits for enrollees with a qualifying medical condition Periodontal scaling and root planing – 1 in 24 months for each area of the mouth Crown lengthening – once per tooth, per lifetime	30%	40%	0%
Oral Surgery	30%	40%	0%
General Anesthesia	40%	40%	0%
Intravenous Sedation	50%	50%	0%
Miscellaneous Services (occlusal guard, athletic mouth guard)	50%	50%	0%
Other Restorative Crowns, onlays, buildups and posts and cores – 1 in 5 years	50%	50%	50%
Implant Services	50%	50%	50%
Prosthodontic Fixed and removable prosthetics	50%	50%	50%
Orthodontic	50%	50%	50%
Medications	50%	50%	0%

OCONUS cost shares only apply to command-sponsored enrollees receiving care in OCONUS service areas. These cost shares do not apply Selected Reserve (Sel Res) and Individual Ready Reserve (IRR) family members and IRR (other than special mobilization category) members. Beneficiaries in this category and/or non-command sponsored members are subject to CONUS cost-share arrangements as noted in the middle two columns above.

Space maintainers for posterior teeth for patients under age 19 are fully covered.

For questions about what is covered for dental emergencies, please refer to the TDP Dental Handbook.

Orthodontic treatment is covered for the following enrolled family members:

Children up to age 21 or 23, based on student status

Spouses up to age 23
National Guard/Reserve sponsors up to age 23

*Note - Braces and Invisalign may only be covered when seeing a dentist in office

YOUR DENTAL PLAN INCLUDES TDP

Wellness Program

Improved TRICARE Benefits for People With Certain Chronic and Medical Conditions

If you or an enrolled family member has been diagnosed with a chronic illness, is pregnant or has special needs, the TDP Wellness Program provides additional dental benefits at no cost to you. Getting the proper treatment and maintenance for gum disease will have a positive effect on your overall wellness as scientists continue to uncover connections between certain medical conditions and gum disease.

TDP Wellness Program is for people with the following chronic and medical conditions:

Cerebral Vascular Disease (stroke)

Coronary Artery Disease (heart)

Diabetes

Lupus

Oral Cancer

Organ Transplant

Rheumatoid Arthritis

Pregnancy (additional, third cleaning in a consecutive 12-month period, only)

Sign into My Account using your DS Login

Select Manage My Wellness

Select Add your medical condition

With TDP Wellness Program you’ll get full coverage for periodontal services, including surgical procedures, to remove the financial obstacles to total oral care.

Improved TRICARE Benefits

Service	Coverage
Periodontal maintenance – an additional service per year	100%*
Scaling and root planing	100%*
Periodontal surgery – four procedures**	100%*

* Standard frequency limitations apply

** Four procedures related to gingival flap or osseous surgeries

The program also includes email outreach designed to educate and encourage you to stay on track with your oral care to better manage your condition. You can request to receive regular monthly emails full of tips to keep you aware of the importance of oral health.