Justice in Aging • www.justiceinaging.org • FACT SHEET • 1
Denti-Cal for Adults
• Make sure your dental provider accepts Denti-Cal.
You should ask whether your provider accepts Denti-Cal. You can also search
the online Denti-Cal provider list at http://www.dentical.ca.gov/WSI/Bene.
jsp?fname=ProvReferral.
• Find out what’s covered.
Not all dental services are covered by Denti-Cal. The table on p. 2 shows what’s
covered and what’s not.
• Denti-Cal must authorize some services.
For some services, your dental provider has to get authorization before treating you.
Sometimes x-rays are needed.
• Coverage Cap.
Denti-Cal will only provide up to $1800 in covered services per year. Some services
are not counted towards the cap, such as dentures, extractions, and emergency
services. Your dental provider must check with Denti-Cal to nd out if you have
reached the $1800 cap before treating you.
• Appeals.
You should receive a notice from Denti-Cal any time a service is denied. You have a
right to appeal any denied service. Call Health Consumer Alliance at 888-804-3536 if
you do not receive a notice or want help with an appeal.
• Billable Services.
Your provider must tell you which services are and are not covered by Denti-Cal. The
provider also must tell you that you will be responsible for paying for non-covered
services. Your Denti-Cal provider cannot charge you for services that are covered by
Denti-Cal.
FACT SHEET
What You Need to Know
If you have Medi-Cal, you also have dental coverage under Denti-Cal. Here is
important information you need to know.
Justice in Aging • www.justiceinaging.org • FACT SHEET • 2
Denti-Cal Services*
Not all dental services are covered by Denti-Cal. There are also limitations on
how often you can get services.
Major Covered Services How Often Pre-Authorization
Initial Exam One per provider No
Cleaning One per year No
Fluoride Treatment One per year No
X-Rays** Every 3 years No
Fillings Every 3 years No (x-rays needed)
Crowns (resin & stainless steel
only – not porcelain)
Every 3 years No (x-rays needed)
Root Canals (front teeth only)
Once per tooth
(retreatment after
12 months)
Yes (x-rays needed)
Full Dentures Every 5 years Yes (x-rays needed)
Full Denture adjustments &
Repairs
Twice in a
12-month period
No
Extractions (& services that can
be performed by a physician)
As needed No
Not Covered
Root Canals (back teeth)
Partial Dentures, Bridges, or Implants
Gum Treatment
Orthodontic Treatment
*These are dental services available to adults living in the community. If you live in nursing
facility or in an intermediate care facility, Denti-Cal covers more services. Services for
children and pregnant women are also different.
**There are a number of different x-rays that are covered with different limitations on how
often they are covered.
