FDCi Membership Services & Benefits
OHP Benefits ‐ Quick Reference Guide
Dental Covered and Non‐Covered Services Chart & More
|Services||Pregnant Women & under 21||21 & Over who are Not Pregnant|
|Exams||2 Every 12 mo.*||1 every 12 mo.|
|Cleanings||2 Every 12 mo.*||1 every 12 mo.|
|Flouride||2 Every 12 mo.*||1 every 12 mo.|
|Root Canal||PA Required**||PA Required***|
|Retreat Root Canal||PA Required--anterior only||PA Required--anterior only|
|Crowns||PA Required||PA Required|
|Dentures||PA Required||PA Required|
|Wisdom Teeth||PA Required||PA Required|
PA = Prior Authorization
* For children 18-years of age and under.
** Wisdom teeth, and 2nd molar for pregnant women, not covered.
*** Wisdom teeth and molars not covered.
Your FDCi OHP dental plan is a managed care plan. You may choose any clinic or dental office in the FDCi network as your primary care dentist (PCD). Your PCD will work with you to take care of your dental needs. Call your PCD before seeking dental care. See the provider directory or call FDCi Customer Service for your PCD’s phone number.
Ride To Care
Your OHP membership includes medical transportation options provided by Ride To Care. Please contact your medical or dental plan for more information.Learn More
Passport To Languages
Your FDCi membership also includes Passport To Languages translation services. Call them to schedule a translator in your native language for your next dental appointment.Learn More