Notice
Change Healthcare announced a breach of HIPAA privacy and is reaching out to individuals whose personal information may have been compromised. Although this incident does not involve Delta Dental of New Jersey or Connecticut, Change Healthcare is a vendor we used and we are providing this information to help our members who might be affected.
Plan changes for 2025
2024 to 2025 Plan Comparison
| Service | Current (2024) | Change Effective 1/1/25 |
| Periapical X-Rays |
No frequency limit (up to 7 per day; more would be considered full-mouth series) |
4 films per calendar year |
| Bitewing X-Rays |
1 per calendar year for adults 19 and older and 1 for children |
1 per calendar year for adults and older and 2 for children |
| Intraoral occlusal X-Rays |
7 per day |
2 per calendar year |
| Specialty consultation |
2 per year; counted as exams for purposes of frequency limitations |
No frequency limit |
| Topical application of flouride |
Covered up to age 19; 1 per calendar year |
Covered up to age 19; 2 per calendar year |
| Sealants | 1 per tooth every 3 calendar years up to age 15 for permanent unrestored 1st and 2nd molars, excluding wisdom teeth and bicuspids | 1 per tooth every 3 calendar years up to age 19 for permanent unrestored bicuspids and molars, excluding wisdom teeth |
| Basic restorations | Replacement once every year | Replacement once every 2 calendar years per tooth on the same surface |
| Periodontal scaling and root planing |
1 per 12 months per unique quadrant | 1 per 24 months per unique quadrant |
| Endodontics - root canal therapy (RCT) (anterior, bicuspid) |
1 per tooth per lifetime; retreatment covered after 24 months if done by same provider and after 1 year if different provider; no limit on retreatment |
1 per tooth plus 1 retreatment per lifetime; retreatment not covered within 180 days of initial RCT |
| *Please note that we are not able to code every 2 per calendar years or every 3 calendar years. The system is code 1 per 2 years, or 1 per 3 years |
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| Endodontics - root canal (molar) |
1 per tooth per lifetime; retreatment covered after 24 months if done by same provider and after 1 year if different provider; no limit on retreatment |
1 per tooth plus 1 retreatment per lifetime; retreatment not covered within 180 days of initial RCT |
| Periodontal surgery (D4210 to D4285) |
Basic category | Major category |
Prosthetics: crowns, inlays, onlays, dentures and bridges |
1 replacement every 5 years |
1 replacement every 84 months |
| Labial vaneers (anterior teeth only) | 1 replacement every 5 years |
1 replacement every 84 months |
| Bruxism | 1 appliance every 5 years |
1 appliance every 36 months; Major category |
| Dental implants | 1 replacement every 5 years |
Implants covered; 1 replacement every 84 months |
| Cone beam CT (CBCT) | Not covered |
2 times per calendar year; Preventive and Diagnostic Category |
| Denture reline/rebase | 1 every 6 months | Not covered within 6 months of installations, afterwards, one per 36 months |
| Denture and bridge repairs | 1 every 6 months | Not covered within 6 months of installation, afterwards limited to once per calendar year |
*Special Needs Health Care program covers a sedation/anesthesia or nitrous oxide for individuals identified with sensory processing disorders. Special health care needs include any physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairment or limiting condition such as anxiety due to autism spectrum disorder (ASD), down syndrome, cerebral palsy or other condition associated with sensory processing disorder that requires medical management, healthcare intervention, and/or use of specialized services or programs.
The condition may be congenital, developmental, or acquired through disease, trauma, or environmental cause and may impose limitations in performing daily self-maintenance activities or substantial limitations in a major life activity. There are no age restrictions under the Special Needs Health Care program. There are no restriction as to type of services that are payable with sedation/anesthesia or nitrous oxide under this program.
We don’t add a comment for groups who elect the Special Needs Health Care program since this is coded and displayed in ICE.
BD Member Benefits and Resources
Delta Dental of New Jersey is a part of Delta Dental Plans Association. Through our national network of Delta Dental companies, we offer dental coverage in all 50 states, Puerto Rico and other U.S. territories.
