Are Dental Cleanings Covered by Delta Dental? Find Out Now!

Understanding coverage basics

When you’re weighing your options for dental cleanings covered by Delta Dental, it helps to know how preventive dentistry fits into your overall oral health strategy. Routine cleanings play a vital role in removing plaque, tartar and bacteria from your teeth and gums, reducing the risk of cavities, gum disease and related health issues such as heart disease or stroke. In addition, regular checkups allow your dentist to spot early warning signs of trouble, from cavities to oral cancer.

With Delta Dental’s extensive network of more than 155,000 credentialed providers nationwide, you can usually find in-network dentists who offer discounted rates and streamlined claims processing. As a result, you’ll face less paperwork and avoid paying full fees upfront, since claim payments are sent directly to your dentist (Delta Dental). In this article, you’ll learn how general and preventative services are covered across various plan types, so you can make informed decisions about scheduling cleanings for yourself and your family.

Coverage by plan type

Different Delta Dental offerings—PPO, HMO, Medicaid and Medicare Advantage—come with varying levels of coverage for routine and specialized cleanings. Understanding these differences ensures you get the most value from your benefits.

PPO plan cleanings

• Standard cleaning coverage: Most Delta Dental PPO plans cover two prophylactic cleanings per year at 100% after your deductible is met.
• Specialized cleaning coverage: If you require periodontal maintenance or scaling and root planing, coverage typically ranges from 50% to 80% after deductibles, depending on your specific plan.
• Deductibles and annual maximums: PPO plans often have a separate deductible for preventive care—commonly $0 to $50 per year—and an annual maximum benefit between $1,000 and $2,000.

As a PPO member, you can visit any licensed dentist, but you’ll save the most when you choose an in-network provider. To find a Delta Dental network dentist near you, check the in-network general dentist Delta Dental page.

HMO plan cleanings

• Preventive care focus: Under a DeltaCare USA (HMO) plan, you’ll pay a predetermined copay for each cleaning—often $10 to $30 per visit—regardless of complexity.
• No annual maximum: HMO participants generally do not have an annual maximum, making it easier to access multiple cleanings if needed.
• Referral requirements: You must select a primary care dentist within the network, and referrals are typically needed for specialist services beyond routine cleanings.

HMO plans can be a cost-effective choice if you prefer predictable copays and a defined provider network. For more on dental checkups under HMO-style plans, see routine dental care with Delta Dental.

Medicaid plan cleanings

If you’re enrolled in Medicaid through your state or via Delta Dental’s managed Medicaid offerings, coverage for dental cleanings varies widely:

• Children under 21: Federal guidelines require coverage for at least two preventive visits per year, which includes cleanings, exams and sealants (where appropriate).
• Adults: Coverage depends on state Medicaid rules. Some states provide full preventive benefits at no cost, while others limit adult benefits or require small copays.

To confirm your benefits, contact Delta Dental or your state Medicaid office. You can also review your plan details online through the Delta Dental member portal.

Medicare Advantage cleanings

Original Medicare (Parts A and B) does not cover routine dental services. However, many Medicare Advantage plans include dental benefits through partnerships with carriers like Delta Dental:

• Routine cleanings: Most Advantage plans cover two cleanings per year at no additional cost, subject to network restrictions.
• Additional services: Some plans extend coverage to specialized cleanings, exams and X-rays—often at 80% coverage after a small copay.
• Annual limits: Coverage limits typically range from $1,000 to $1,500 per year across all dental services.

Before scheduling, verify that your provider is listed under the Medicare Advantage network—this ensures you’ll pay the lowest copays and avoid surprise out-of-network charges.

Employer-sponsored plan cleanings

If you receive dental coverage through your employer, your benefits may mirror PPO or HMO structures but can also offer unique features:

• Flexible spending accounts: You can use pre-tax dollars from an HSA or FSA to cover copays and services not fully covered by insurance.
• Tiered networks: Some employer plans categorize dentists into tiers—each with different cost-sharing obligations. In-network dentists typically fall in Tier 1, with the most favorable rates.
• Enhanced benefits: Larger employers may negotiate higher annual maximums or additional cleanings for high-risk conditions.

Check your Summary of Benefits and Coverage (SBC) to understand how many cleanings are covered and any associated copays or deductibles.

Choosing in-network dentist

Selecting an in-network provider is one of the easiest ways to keep your costs down and simplify billing. Here’s why you’ll benefit:

• Credentialed professionals: Delta Dental dentists undergo a thorough credentialing process, so you can trust in their training and qualifications (Delta Dental).
• Negotiated discounts: Network dentists agree to Delta Dental’s fee schedule, which can reduce your share of a bill by up to 25% compared with out-of-network rates.
• Streamlined claims: Your dentist’s office handles paperwork, submitting claims on your behalf and receiving direct payment. That means you avoid paying the full bill upfront.

To locate a provider, use the Delta Dental online directory or consult the in-network dentist for exams and cleanings resource.

Estimating your out-of-pocket costs

Planning ahead for dental expenses helps you avoid surprises. Delta Dental’s Cost Estimator tool offers estimated ranges for various services, but remember it does not guarantee exact fees, benefits or out-of-pocket costs (Delta Dental). For a clearer picture, compare average costs without benefits against typical coverage levels.

As you can see, routine cleanings often cost you nothing if they’re fully covered. For specialized procedures, review your plan’s coverage percentage and deductible to calculate your share.

Preventive services beyond cleanings

Delta Dental plans frequently include other preventive services that protect your oral health:

• Fluoride treatments: Covered at 100% for children under age 19 and often 80% for adults, depending on your plan. To find a provider, visit Delta Dental fluoride treatment provider.
• Dental sealants: Typically covered at 100% for children up to age 15 when applied to first and second molars. Learn more on dental sealants covered by insurance.
• Digital X-rays: Covered as part of diagnostic services—often at 80% to 100%—with minimal copays. For details, see insurance accepted for dental x-rays or digital x-rays covered by Cigna.
• Oral cancer screening: Many plans include an annual screening at no extra cost. Although Delta Dental covers this service, you can compare with oral cancer screening with BCBS Dental to understand different carrier policies.

By combining these services with your routine cleanings, you’ll build a comprehensive preventive care regimen that reduces long-term treatment needs.

Maximizing your dental benefits

To make the most of your Delta Dental coverage:

• Schedule two cleanings and exams annually, ideally six months apart.
• Confirm your dentist’s network status before booking appointments.
• Monitor deductibles and calendar-year maximums—plan any major work early in the year.
• Use HSA or FSA funds to cover copays, deductibles and any services outside your coverage.
• Preauthorize specialized procedures through Delta Dental to avoid unexpected costs.
• Stay informed about plan changes during open enrollment each year.

By following these steps, you’ll control costs while keeping your smile healthy.

Frequently asked questions

Q: How many cleanings does Delta Dental cover per year?
Most plans cover two routine cleanings (prophylaxis) per calendar year. Coverage for additional cleanings—such as periodontal maintenance—depends on your plan type and any coexisting gum disease.

Q: Do I need a referral for specialist cleanings?
Under PPO plans, no referral is required. HMO plans may require you to see your primary dentist first, who will issue a referral for specialty services.

Q: Does Delta Dental cover cleanings for children under Medicaid?
Yes, federal guidelines mandate at least two preventive visits, including cleanings, for children under age 21. Adult coverage varies by state.

Q: Can I get cleanings if I have Medicare Advantage?
If your Medicare Advantage plan includes dental benefits, you’ll typically receive two cleanings per year at no extra cost in-network. Always verify coverage details with your plan provider.

Q: Are specialized cleanings like scaling and root planing covered?
Many plans offer partial coverage (50% to 80%) for periodontal procedures after deductibles. Check your plan’s Summary of Benefits and Coverage for specifics.

Q: What should I do if my provider is out-of-network?
You’ll face higher out-of-pocket costs. Consider switching to an in-network dentist for your preventive care to benefit from negotiated rates and simpler claims.

If you still have questions about your coverage or need help locating an in-network general dentist, visit the in-network general dentist Delta Dental directory or contact Delta Dental customer service.