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DenteMax PPO Exclusions, Missing Tooth Clause, Limitations and Frequency Rules

DenteMax PPO Exclusions, Missing Tooth Clause, Limitations and Frequency Rules

There are both similarities and differences between individual dental insurance policies. At Sunnyvale Dental Care we will not assume that we know all of the details of your DenteMax PPO insurance plan. We will contact DenteMax insurance and request your coverage information so we can help you thoroughly utilize your dental benefits.

Sunnyvale Dentist Dr. Gupta has spent over 22 years providing gentle, quality dental care in the Sunnyvale community and surrounding area. His highly trained staff shares his commitment to provide ethical dental care with the highest standards. Because Sunnyvale Dental Care has many patients with DenteMax PPO insurance coverage, they are thoroughly familiar with the possible exclusions, clauses, limitations and frequency rules on some DenteMax PPO insurance policies.

Missing Tooth Clause

Under this coverage rule, any tooth or teeth extracted or lost prior to the start date of the insurance policy would not be eligible for replacement. In other words, the policy would not cover the cost of a dental implant, fixed bridge, partial denture, or full denture needed to replace a pre-existing missing tooth or teeth.


Some insurance plans will only cover certain materials used to restore teeth. For instance, some policies will pay their full percentage for silver amalgam fillings on posterior or back teeth, but will pay less for a more attractive tooth colored composite filling on the same tooth. Other policies may cover bridges or partials but not implants in the replacement of missing teeth. Services like fluoride and sealant application may be excluded for patients over a specified age.

Limitations and Frequency Rules

Most insurance plans limit dental cleanings to twice per year. Some stipulate that the two cleanings must be at least six months apart. Other insurance plans limit their patients to two cleanings per year, but do not have a rule for the amount of time between cleanings. X-rays and examinations are also only covered if limitations and frequency rules are met. Fortunately not every dental insurance policy has strict coverage rules and exclusions. Sunnyvale Dentist Dr. Gupta will present every available treatment option and help you select an option that qualifies you for as much insurance coverage as possible.

Learn more when you visit Sunnyvale Dental Care. Call Sunnyvale Dentist Dr. Gupta at 408-720-0900 to schedule a consultation today!

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