Most insurance plans from delta dental will provide at least two cleanings per year. That is based on what we see in our private practice based on the hundreds of patients who have delta. However that does not mean that YOUR insurance plan can't provide more than two dental cleanings a year. There are exceptions, which we will explain because you can get lucky.
Aside from that, there is one other stipulation in regards to the frequency limitation which you should pay attention to. The exact language in the contract may affect the number of times you can get your teeth cleaned.
Table of Content:
Average number of cleanings per year
Most delta dental insurance plans will provide at least two dental cleanings per year. What that means is that most people will go twice per year roughly six months apart to have their chompers cleaned.
We'll provide evidence below.
We've included a screenshot of one of patient's benefit breakdown who has delta dental. If you look at the dental prophylaxis (dental cleaning) section, it says 2 visits every 1 calendar year is permitted.
Basically, this patient can get their cleaning two times this year and have both visits be fully covered. Although if they try to go for a third visit, it will not be covered and they'll be responsible for it out of pocket.
Delta dental may allow more than 2 cleanings per year
Even though most delta plans permit 2 per year, there are some plans that allow 3 or even 4 cleanings per year. Yes, you read that correctly, you can potentially get your teeth cleaned more than twice a year but it depends on your insurance. You need to read the benefit breakdown closely so you know the exact limitations.
We've attached a screenshot of a benefit breakdown of a different patient above. Here you can see that the frequency limitation for their dental prophylaxis is 3 visits every year! In other words, they can get their teeth cleaned three times a year instead of two and still be fully covered.
Can you have more than 4 per year?
We have seen some plans that permit 4 dental prophylaxis per year but we haven't seen any allowing more than that. Four would be the limit for how many you could potentially get.
Aside from insurance limitations, from a clinical standpoint, there is no reason to need more than 4 per year anyway. Even the most severe periodontal disease would only require you to be on a 3 month or 4 times per year recall schedule.
Stipulations in frequency limitations
The exact wording in the frequency of limitations for your cleaning is important in understanding your benefits. If you interpret it incorrectly, your treatment may not be fully covered.
There are four types of wording in regards to frequency limitations:
Twice per calendar year
Twice per plan year
Once every 6 months
Twice every 12 months
All three of them may sound similar and you may think they mean the same thing but THEY DO NOT. Each of them have separate nuances as to when you can see the dentist.
Twice per calendar year
A cleaning twice per calendar year means that you can get it two times this year. You can also get it two times the next year, so on and so forth.
Interesting caveat: You can technically get your cleaning today and then get another one tomorrow. Both visits will be valid and they will both be fully covered. However you will have no more visits left for the rest of the year.
Twice per plan year
A clean twice per plan year is different than twice per calendar year. A plan year may not necessarily begin on January 1st. We've seen some insurance plans that have a plan year starting on July 1st.
Interesting caveat: If you JUST got the insurance active on 1/1/23 you can technically get in two cleanings before 7/1/23. Once 7/1/23 passes, your insurance will refresh and you can technically squeeze in another TWO cleanings before the end of december.
All in total, you can get 4 cleanings in that one year based on this interesting loop hole. Now isn't that interesting?
Once every 6 months
If your delta dental plan says that you can get a cleaning every 6 months, it means that it needs to be at least 6 months apart. In order to get full coverage you would have to wait 6 months plus 1 day for it to be effective.
Interesting caveat: If you get your second cleaning 1 day before the 6 month time period, that cleaning will NOT be covered. Due to this stipulation, we recommend waiting at least 6 months and an extra day so that your insurance can't deny the claim.
Twice every 12 months
If your delta dental plan says that you can get a cleaning twice every 12 months, it means exactly that. Within a 12 month period you can get them cleaned twice.
Interesting caveat: This is one of the most confusing wording because it does not follow "per calendar year" or "per plan year". The twice per 12 months wording technically creates its own "plan year".
What we mean by that is that if you get your first cleaning on March 1st. Your plan year will begin on march 1st and refresh every march 1st!
Takeaway
In summary, you can expect to have two cleanings per year if you have delta dental insurance. Although if your plan is generous you may be able to get more than two. Nonetheless if you're ever in doubt, you should check with your insurance or ask your dentist as to what the exact wording for the frequency limitation is. There may be a nuance to it!
FYI, our dentists in Long Island City do accept and are in network with delta dental.
