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. HPSM providers can help members 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 (or up to 4 times per year for members 12 and under with high risk for cavities)
Full mouth x-rays
Once every 3 years (additional x-ray benefits available; urgent x-rays allowed as needed)
Teeth cleaning
Every 6 months (or up to 4 times per year for members 12 and under with high risk for cavities)
Deep cleaning
Every 2 years (13 or older only)
Fillings
- Baby tooth: once a year
- Permanent tooth: once every 3 years
Fluoride varnish
As often as needed
Tooth removal (including wisdom teeth)
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)
Sealants
Once per tooth every 3 years
Root canal
As often as needed
Dentures (partial & full)
Every 5 years
Orthodontics (braces)
For children who qualify (when medically necessary or correction is needed)
Sedation
Covered when medically necessary
Nightguard
Not covered
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
2 times per calendar year
Deep cleaning
Every 2 years
Fillings
Every 3 years per tooth
Fluoride varnish
As often as needed
Tooth removal (including wisdom teeth)
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)
Implants & bridges
Only a benefit for exceptional medical conditions, and requires review from Dental Director
Bone graft
Not covered
Nightguard
Not covered
Orthodontics (braces), implants & bridges
Not covered
Cost of dental services
With some exceptions, you should not be billed by any provider for any services covered by Medi-Cal and HPSM Dental.
Before you pay for any dental services, contact us
If you have questions regarding a treatment plan or cost estimate presented to you by your dentist, or if you would like a second opinion, please contact the HPSM Dental Unit:
- Phone: 650-616-1522
- Hours are Monday–Friday 8:00 a.m. to 5:00 p.m.
- If you get voicemail, leave a message – we will call you back within one business day
- Email: dental@hpsm.org