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Aetna Dental®  insurance through work

From your choice of dentists to discounts and digital tools, Aetna Dental plans help make staying healthy simpler.

 

This content is pending approval in AZ, CA, ID and WV.

More choices nationwide

Choose from thousands of dentists and dental providers in the Aetna® network, including those who offer virtual visits.

Get to know our dental plans

All plans include access to board-certified, in-network dental providers, health discounts and digital tools. Specific features, costs and state guidelines* depend on the plan you choose. Ask your employer which plans are available to you.

Aetna Dental plans at a glance

Plan typeDentist choiceOut-of-network carePremiumsDeductibles and annual maximumsReferralsConsider this plan if:
Dental DMOChoose a primary care dentist (PCD) in the DMO network.Not covered, except where state laws applyLower than PPONoneRequiredYour dentist is already in the DMO network and lower costs matter most.
Dental PPOChoose any dentist in or out of network. No PCD required.Covered, but you may pay moreHigher than DMOMay applyNot RequiredYou want the freedom to visit any dentist and see specialists without referrals.
Dental EPOChoose a dentist in the EPO network. No PCD required.Not coveredVaries by employer plan May applyNot requiredYou’re comfortable seeing only in-network dentists and don’t want referrals.
Dental FOC

Choose a PCD in the network: DMO

 

Choose a dentist in or out of network: PPO

Not covered, except where state laws apply: DMO

  

Covered: PPO

Same for DMO and PPOBased on your choice of DMO or PPO plan

Required: DMO

 

Not required: PPO

You want the flexibility to switch between plan options as your needs change.
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Guided care with predictable costsHow our dental DMO plan works

Pick your dentistGet careKnow your costs

Choose a primary care dentist (PCD). Covered family members can choose their own PCDs.

 

To find your PCD: Choose a dentist in our network. This gets you on that dentist's list of patients.*

 

To change your PCD: Choose a new PCD on your member website by the 15th. The change will take effect on the first day of the next month.

Start with your PCD when you need care. If you see another dentist, you could pay more.

 

For routine care: See your PCD for services like exams, cleanings and fillings. Your PCD files claims for you.

 

For specialist care: Get referrals from your PCD for services like root canals and oral surgery. You don’t need referrals for orthodontists.

Check your benefits summary on your member website before your visit.

 

What you pay: You pay a copay (a set dollar amount) or coinsurance (a percentage of the dentist’s fee).

 

How you save: There are no deductibles and no annual maximums. Just pay your copay or coinsurance at your visit.

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Flexible care in or out of networkHow our dental PPO plan works

Pick your dentistGet careKnow your costs

See a dentist in our network. You don’t need a primary care dentist.

 

To see an in-network dentist: Use our search tool to find a dentist in our network.

Choose how and where you get care every time you need it.

 

 Go in network: See an in-network dentist. They file your claim for you.

 

Go out of network: See any out-of-network dentist. You may need to file your claim.

 

Go to specialists: Get services like root canals and oral surgery with no referrals.

 

Go online: Get virtual evaluations, second opinions and prescriptions from Dental.com and TheTeleDentists.

 
Check your benefits summary on your member website before your visit.

 

In network: Dentists agree to special rates, so your costs may be lower.

 

Out of network: Dentists set their own rates, so your costs may be higher.

 

Other costs: You may have deductibles and annual maximums.

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In-network care with no referralsHow our dental EPO plan works

Pick your dentistGet careKnow your costs

See any dentist in our network. You don’t need a primary care dentist.

 

To find a dentist: Use our search tool to find a dentist in our network.

 

Stay in network: Out-of-network care isn’t covered.

Get covered care from local dentists in the EPO network. 

 

For routine care: See an in-network dentist for exams, cleanings, fillings and other services.

 

For specialist care: See an in-network specialist for services like root canals and oral surgery with no referrals.

Check your benefits summary on your member website before your visit.

 

What you pay: You pay coinsurance (a percentage of the dentist's charge) for covered dental services.

 

Other costs: You may have deductibles and annual maximums.

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Freedom to choose the plan that fits youHow our dental FOC plan works

Pick your dentistGet careKnow your costs

Choose your dentist based on whether you use the DMO or PPO option.

 

Choose DMO: Find a dentist in the network. Then choose them as your primary care dentist (PCD).

 

Choose PPO: See any dentist in or out of network. You don’t need a PCD.

Switch between DMO and PPO coverage each month as your dental needs change.

 

DMO care: See your PCD. They file claims for you and refer you to specialists. You don’t need referrals for orthodontists.

 

PPO care: See any dentist in or out of network. You don’t need referrals for specialists. You may need to file a claim for out-of-network care.

Check your benefits summary on your member website before your visit.

 

DMO costs:  You may pay less with predictable costs. There are no deductibles and no annual maximums.

 

PPO costs: You may pay more for greater flexibility. There may be deductibles and annual maximums.

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Benefits beyond dental coverage

Aetna Dental plans give you added value to help you stay healthy and save money.

For state guideline details 

DMO plans 

In Illinois, the Aetna Dental DMO plan provides limited out-of-network benefits. To receive maximum benefits, members must choose a primary care dentist (PCD) to coordinate their care. In Illinois, the Aetna Dental DMO plan is not a health maintenance organization (HMO). In Virginia, the DMO plan is known as the Aetna Dental network only plan (DNO). DNO in Virginia is not an HMO. To receive maximum benefits, members must choose a participating PCD to coordinate their care with in-network providers. In California, your dentist may refer you to out-of-network dentists for some services.

 

PPO plans 

In Texas, the preferred provider organization (PPO) plan is known as the participating dental network (PDN).

For dentist’s list of patients

Your primary care dentist (PCD) keeps a list of eligible patients that is updated monthly. Your name will appear on this list the month after you choose your PCD. Some dentists will only treat patients whose names are on this list. If your dentist needs to confirm your eligibility, call Member Services.

Legal notices

DMO plans are insured by Aetna Life Insurance Company, Aetna Dental Inc., Aetna Dental of California Inc. and/or Aetna Health Inc. (Aetna). Dental policies and plans are insured and/or administered by Aetna Life Insurance Company (Aetna). Each insurer has sole financial responsibility for its own products.

Not all services are covered. See plan documents for a complete description of benefits, exclusions and limitations of coverage. Plan features and availability may vary by location and are subject to change. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Refer to Aetna.com for more information about Aetna® plans.

This material is for information only. Dental information programs provide general dental information and are not a substitute for diagnosis or treatment by a dentist or other health care professional. Information is believed to be accurate as of the production date; however, it is subject to change.

DISCOUNT OFFERS ARE NOT INSURANCE. They are not benefits under your insurance plan. You get access to discounts off the regular charge on products and services offered by third party vendors and providers. Aetna makes no payment to the third parties — you are responsible for the full cost. Check any insurance plan benefits you have before using these discount offers, as those benefits may give you lower costs than these discounts. 

Policy forms issued in Missouri by Aetna Dental Inc. include: DM HGrpAg-Dental 04.
Policy forms issued in Oklahoma include: AL HGrpPol-Dental 04.
Policy forms issued in Washington include: AL WA HGrpPol-Den 05, AL SG HGrpPol-2019 04. 
Policy forms issued in Wyoming by Aetna Life Insurance Company include: AL IVL CB-HDentalPOL 05. 
Policy forms issued in Missouri include: DM HGrpAg-Dental 04, AL HGrpPol-Dental 04 [Dental ALIC]. 
Policy forms issued in Oklahoma include: AL HGrpPol-Dental 04, AL HCOC-DentalPPO 05. 
Policy forms issued in Wyoming include: AL HGrpPol-Dental 02. 
Policy forms issued in Washington include: AL WA HGrpPol-Den 05, AL SG HGrpPol-2019 04.

Dental benefits and dental insurance plans contain exclusions and limitations.

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Applied Behavior Analysis Medical Necessity Guide

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The Applied Behavior Analysis (ABA) Medical Necessity Guide helps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. The ABA Medical Necessity Guide does not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any matters related to their coverage or condition with their treating provider.

Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply.

The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. The member's benefit plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary.

Please note also that the ABA Medical Necessity Guide may be updated and are, therefore, subject to change.

Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law.

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ASAM Terms and conditions

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Licensee's use and interpretation of the American Society of Addiction Medicine’s ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits.

 

This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose.

 

Copyright 2015 by the American Society of Addiction Medicine. Reprinted with permission. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM.

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Precertification lists

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Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept".

 

  • The term precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members.
  • Applies to: Aetna Choice® POS, Aetna Choice POS II, Aetna Medicare℠ Plan (PPO), Aetna Medicare Plan (HMO), all Aetna HealthFund® products, Aetna Health Network Only℠, Aetna Health Network Option℠, Aetna Open Access® Elect Choice®, Aetna Open Access HMO, Aetna Open Access Managed Choice®, Open Access Aetna Select℠, Elect Choice, HMO, Managed Choice POS, Open Choice®, Quality Point-of-Service® (QPOS®), and Aetna Select℠ benefits plans and all products that may include the Aexcel®, Choose and Save℠, Aetna Performance Network or Savings Plus networks. Not all plans are offered in all service areas.
  • All services deemed "never effective" are excluded from coverage. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. Visit the secure website, available through www.aetna.com, for more information. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search."
  • The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT®), copyright 2025 by the American Medical Association (AMA). CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians.
  • The responsibility for the content of Aetna Precertification Code Search Tool is with Aetna and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Precertification Code Search Tool. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Applicable FARS/DFARS apply.

 

LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT®")

 

  • CPT only Copyright 2025 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to sue CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt.

 

U.S. Government Rights

 

  • This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

 

Disclaimer of Warranties and Liabilities.

 

  • CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CPT. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product.
  • This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.
  • Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept".
  • The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services.
  • This information is neither an offer of coverage nor medical advice. It is only a partial, general description of plan or program benefits and does not constitute a contract. In case of a conflict between your plan documents and this information, the plan documents will govern.
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Dental clinical policy bulletins

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  • Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Treating providers are solely responsible for dental advice and treatment of members. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider.
  • While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Aetna's conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna). Your benefits plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government.
  • Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change.
  • Since Dental Clinical Policy Bulletins (DCPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies.
  • Under certain plans, if more than one service can be used to treat a covered person's dental condition, Aetna may decide to authorize coverage only for a less costly covered service provided that certain terms are met.
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Medical clinical policy bulletins

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Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept".

 

  • Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider.
  • While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental, investigational, unproven, or cosmetic. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors).
  • Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error.
  • CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. New and revised codes are added to the CPBs as they are updated. When billing, you must use the most appropriate code as of the effective date of the submission. Unlisted, unspecified and nonspecific codes should be avoided.
  • Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. The member's benefit plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern.
  • In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. 

See CMS's Medicare Coverage Center

 

  • Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change.
  • Since Clinical Policy Bulletins (CPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. Under certain circumstances, your physician may request a peer to peer review if they have a question or wish to discuss a medical necessity precertification determination made by our medical director in accordance with Aetna’s Clinical Policy Bulletin.
  • While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans.

See Aetna's External Review Program

 

  • The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT®), copyright 2015 by the American Medical Association (AMA). CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians.
  • The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Applicable FARS/DFARS apply.

 

LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT®")

 

CPT only copyright 2015 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association.

 

You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins (CPBs) solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT.

 

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt.

 

Go to the American Medical Association Web site

 

U.S. Government Rights

 

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

 

Disclaimer of Warranties and Liabilities.

 

CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CPT. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product.

 

This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

 

Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept".

 

The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services.

 

This information is neither an offer of coverage nor medical advice. It is only a partial, general description of plan or program benefits and does not constitute a contract. In case of a conflict between your plan documents and this information, the plan documents will govern.

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