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Provider Manual

Dental services

Last Updated on February 19, 2026

Delta Dental preventive and supplemental benefits

  • Security Health Plan partners with Delta Dental to provide preventive and optional supplemental dental benefits.
  • Questions about benefits, limitations, covered services, provider network or claims should be directed to Delta Dental Customer Service at 1-866-548-0292.
    • Hours are Monday – Friday 8 AM to 8 PM CST
  • Eligible members will receive a Delta Dental ID card indicating in the "Client" field which dental benefit they have.
  • Claims for services covered under the preventive and optional supplemental dental benefit should be submitted to Delta Dental.

Preventive Dental Benefit:

  • The preventive dental benefit is provided at no cost to all Security Health Plan Medicare Advantage members, with the exception of MSA.
    • Ally Rx D-SNP members have the preventive dental benefit and may also have additional dental coverage through their Wisconsin Medicaid benefits.
  • Preventive dental services must be provided by a Delta Dental Medicare Advantage network dentist.
  • Under the preventive dental benefit, we cover:
    • One preventive dental exam per calendar year
    • One standard preventive cleaning per calendar year
    • One bitewing X-ray per calendar year, except in years when you get the full-mouth or panoramic X-ray
    • Either a full-mouth X-ray or panoramic X-ray once every five years

Optional Supplemental/Enhanced Dental Benefit

  • The Optional Supplemental/Enhanced Dental Benefit is available for purchase to all Medicare Advantage HMO-POS members, except Secure Saver MSA.
  • Dental services must be provided by a Delta Dental Medicare Advantage network dentist. Members will pay 100% of the cost for any services received from an out-of-network dentist.
  • The maximum the plan will pay for services covered under the optional supplemental dental benefit is $1,000 per calendar year.
  • Under the Optional Supplemental/Enhanced dental benefit, we cover:
    • All services listed under the preventive benefit plus one additional exam and one standard preventive cleaning or periodontal maintenance cleaning per calendar year covered at 100%
    • Member pays 20% coinsurance for fluoride treatments and emergency treatment of pain
    • Member pays $100 deductible, then 50% coinsurance for:
      • Major restorative services - crowns and onlays payable once per tooth per 5-year period
      • Minor restorative services – fillings and crown repair
      • Endodontic services – root canals
      • Periodontic services – to treat gum disease
      • Extractions and oral surgery services – extractions and dental surgery
      • Prosthodontic services – bridges, implants and dentures, payable once per tooth per 5-year period
      • Relines and repairs – to bridges, implants and dentures
      • Pulp vitality tests – payable per visit, not per tooth, for the diagnosis of emergency conditions
      • Salivary flow assessment – payable once every 3-year period
      • Other basic services – miscellaneous services

Dental services covered under the medical benefit

  • Security Health Plan Medicare Advantage plans, including Ally Rx D-SNP and Secure Saver MSA, follow Medicare guidelines on coverage for dental services covered under the medical benefit. For information on dental services that Medicare covers see the CMS.gov website.
    • Medicare-covered dental services include:
      • Surgical repair of the jaw after a fracture or injury
      • Reconstruction of the jaw following a facial tumor
      • Extraction of teeth to prepare the jaw for radiation treatments of neoplastic cancer disease
      • Oral examination prior to kidney transplantation or heart valve replacement (does not include coverage for any dental treatments)
      • There is no Medicare coverage for services such as extraction of teeth or tissue to prepare for dentures or to make dentures fit appropriately, or for follow-up dental care after the underlying health condition was treated. These services may be covered if you select the optional supplemental dental benefit
  • Medicare covered dental services must be completed by a Medicare-certified provider to qualify for coverage.
  • Claims for dental services covered under the medical benefit must be submitted to Security Health Plan on a CMS 1500 claim form and be submitted using CPT/HCPCS codes.
    • Claims submitted with dental codes (D codes) or on a dental claim form will be denied.
  • To view a member’s eligibility and benefits log in to the Security Health Plan  Provider Portal.
  • For plan specific documents such as the Evidence of Coverage (EOC), see https://www.securityhealth.org/brokers/document-library/medicare-documents.