CareAdvantage members
Call 1-866-880-0606 or 650-616-2174 Monday–Sunday 8:00 a.m. to 8:00 p.m.
TTY: 1-800-735-2929 or dial 7-1-1
Email: CustomerSupport@HPSM.org
Medi-Cal and HealthWorx members and ACE Program participants
Call 1-800-750-4776 or 650-616-2133 Monday–Friday 8:00 a.m. to 6:00 p.m.
TTY: 1-800-735-2929 or dial 7-1-1
Email: CustomerSupport@HPSM.org
Covered Dental Services
Below is a quick reference guide for common services available to members. There is no limit for covered, medically necessary dental services. Your dentist can help you pick the best treatment and determine which services you can get through your HPSM Dental coverage.
Covered services for kids (up to 21 years old)
Service
When it is covered
Dental exam
Every 6 months
Full mouth x-rays
Once every 3 years (additional x-ray benefits available; urgent x-rays allowed as needed)
Teeth cleaning
Every 6 months
Deep cleaning
Every 2 years (13 or older only)
Fillings
- Baby tooth: once a year
- Permanent tooth: once every 3 years
Fluoride varnish
Every 4 months
Tooth removal
As often as needed
Emergency services
As often as needed
Crowns
- Baby tooth: once a year
- Permanent tooth: every 3-5 years (depending on crown type)
Molar sealant
Once per tooth every 3 years
Root canal
As often as needed
Dentures (partial & full)
Every 5 years
Dentures (partial & full) adjustments & repairs
2-4 times per year (depending on the adjustment or repair needed)
Orthodontics (braces)
For children who qualify (when medically necessary, or correction is needed)
Covered services for adults (21 and older)
Members living in a nursing facility or intermediate care facility are eligible for more services. Pregnant women also have additional benefits. For more information about covered benefits, see your Member Handbook.
Service
When it is covered
Dental exam
Once a year
Full mouth x-rays
Once every 3 years (additional x-ray benefits available; urgent x-rays allowed as needed)
Teeth cleaning
Once a year
Deep cleaning
Every 2 years
Fillings
Every 3 years per tooth
Fluoride varnish
Every 4 months
Tooth removal
As often as needed
Emergency services
As often as needed
Crowns
Every 3-5 years (depending on crown type)
Molar sealant
Not covered
Root canal
As often as needed
Dentures (partial & full)
Every 5 years
Dentures (partial & full) adjustments & repairs
2-4 times per year (depending on the adjustment or repair needed)
Orthodontics (braces), implants & bridges
Not covered
Cost of dental services
Unless you have Medi-Cal coverage with a Share of Cost, your dentist cannot ask you to pay for any treatment that is covered by Medi-Cal Dental. You can learn about your Share of Cost in the “My Medi-Cal” booklet from the California Department of Health Care Services.
HPSM dentists cannot charge you for private insurance cost-sharing amounts. This includes deductibles, co-insurance or private insurance copayments.
If you have other dental coverage, HPSM Dental will be your secondary coverage.