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What's covered?
What's covered?
Aetna Assure Premier Plus (HMO D-SNP) covers all medically necessary dental treatment with a comprehensive dental benefit. Every member with an Aetna Assure Premier Plus (HMO D-SNP) plan gets access to this dental benefit, including members who qualify for:
Plans A, B, C, D or the Alternative Benefit Plan
Managed Long-Term Services and Supports (MLTSS)
Fully Integrated Dual-Eligible Special Needs Plan (FI D-SNP)
Our members are covered for many general services, including:
Diagnostic services
Preventive services
Restorative services
Endodontic services
Periodontal services
Prosthetic services
Oral surgical services
Other adjunctive general services
Some procedures may require prior authorization with documentation of medical services. You can learn more about dental benefits in our Provider Manual (PDF).
LIBERTY Dental Plan providers
Aetna Assure Premier Plus (HMO D-SNP) uses LIBERTY Dental Plan to provide dental services for our members. LIBERTY Dental Plan covers routine and specialty dental services, the administration of the dental network, and claim payment for dental services.
To learn more, you can reach LIBERTY Dental Plan:
Members don’t need a referral to see a network dental provider. They can find a dentist using LIBERTY Dental Plan’s provider search tool.
New Jersey Smiles program
Through the NJ Smiles program, Primary Care Providers (PCPs) can apply fluoride varnish to children’s teeth as a preventive measure against cavities. They just need to receive appropriate training for this service.* They can also provide a cavity risk assessment and a dental referral for children 6 years or younger.
*PCPs (pediatricians or physicians seeing pediatric enrollees), physician assistants and nurse practitioners can receive this training.
All primary care dentists and PCPs should be up to date on prescribing fluoride supplements (based on access to and use of fluoridated public water). They’re also responsible for counseling parents and guardians of young children on oral health and age-appropriate oral habits and safety. And they should go over what dental emergencies are and how to use the emergency room for dental services.
Fluoride varnish application will be combined with risk assessment and referral to a dentist who treats children under the age of 6. The services will be linked to well-child visits for children under the age of 6. They’ll also be reimbursed as an all-inclusive service billed using a current procedural terminology (CPT®) code and can be provided up to four times a year.
The state periodicity schedule requires that a child be referred to a dentist for a dental visit before the child turns 12 months old.
The carries-risk assessment service:
- is billed using a CPT code (the reimbursement will be the same regardless of the determined risk level),
- must be provided at least once per year in conjunction with an oral evaluation service, and
- must be provided by a primary care dentist.
It may be provided a second time with prior authorization and documentation of medical necessity.
Aetna NJ Child Provider Directory (PDF)
Directory of Dentists Treating Members with Intellectual and Developmental Disabilities Adult (PDF)
Directory of Dentists Treating Members with Intellectual and Developmental Disabilities Child (PDF)
The NJFC Directory of Dentists Treating Children under the Age of 6 (PDF)
Have a question?
To learn more about our dental benefits, view the Provider Manual (PDF) or call Provider Experience at 1-844-362-0934 (TTY: 711).
CPT® is a registered trademark of the American Medical Association.