Your guide to no-surprises dental care Every Devoted Health plan includes dental benefits to make taking care of your teeth easy and affordable. The best way to avoid surprise costs at the dentist is to ask for an estimate before you get any care. This guide can help. It lists all the covered dental codes for 2024 Devoted Health plans that cover: • Preventive services like cleanings and X-rays • Basic services like fillings and extractions • Major services like dentures, crowns, and root canals This guide is for plans that cover the services listed above through Liberty Dental or Delta Dental. Check the back of your member ID card to see if your coverage is through Liberty or Delta. You may need prior authorization for some services. There are just a few cases where your coverage might be different: • If your plan only covers preventive and basic services, there's a different list of covered codes. Visit devoted.com/dental/codes-2024 or text or call us to get a copy. • If your plan has a dental benefit card or yearly allowance that's not through Liberty or Delta, there’s no list of covered codes. See your plan documents for more details about how your dental benefit works. • If you also have Medicaid benefits, Medicaid may cover extra dental services in addition to what your Devoted Health plan covers. Call us for details. For more details about your plan’s dental coverage, visit devoted.com/find-plan-documents to look up your plan documents. Questions? Text 866-85 or call us at 1-800-338-6833 (TTY 711). We’re here Monday to Friday, 8am to 8pm (from October 1 to March 31, 8am to 8pm, 7 days a week). Y0142_24S264_M 1