IQVIA Benefits Handbook
BENEFITS COVERED BY THE DENTAL PLAN
The list of services below are covered by the plan if the service is ordered or prescribed by a dentist, essential for the necessary care of teeth and is within the scope of coverage limitations. In addition, charges for these services will be paid only if the deductible is met (if applicable), the maximum benefit is not exceeded and the amount is not more than what is allowed under a suitable treatment plan.
Class I: Preventive and Diagnostic Services
  • Oral exams: Two each calendar year.
  • Emergency treatment for pain relief.
  • X-rays:
    • Bitewing: Two of any bitewing X-ray procedures within a calendar year.
    • Full mouth (10 or more teeth at one time): One within a five (5)-year period.
    • Panoramic: One within a five (5)-year period.
  • Cleanings (routine): Two each calendar year.
  • Fluoride treatment: Once each calendar year (to age 19).
  • Sealants: One per posterior tooth, without caries, within a five (5)-year period.
  • Space maintainers (to age 19).
  • Palliative (emergency) treatment.
Class II: Basic Restorative Services
  • Amalgam fillings.
  • Composite/resin fillings for all teeth.
  • Root canal therapy.
  • Periodontal scaling and cleaning root planing.
  • Periodontal maintenance (cleaning): Two of any cleanings (routine or periodontal) each calendar year.
  • Bridge recement (once per quadrant per lifetime).
  • Extractions:
    • Simple extractions.
    • Endodontic treatment, including root canals.
    • Periodontic treatment or surgery to remove diseased gum tissue or bone.
  • Anesthesia:
    • Local anesthetic, analgesic and routine postoperative care.
    • IV sedation.
  • Pin retention.
  • Therapeutic pulpotomy.
  • Pulp caps: One per tooth (as medically necessary).
  • Apiceotomy.
Class III: Major Restorative Services
  • Osseous surgery.
  • Extractions: Impacted teeth.
  • Crowns and inlays:
    • Crown build-ups and lengthening.
    • Restorations covered only as a result of extensive caries or fracture and cannot be replaced with amalgam, silicate, acrylic or plastic restoration.
    • Crown and inlay recement (once per tooth per lifetime).
  • Onlays.
  • Dentures (full and partial), including adjustments during the six-month period following installation and relining once per arch every three (3) calendar years and more than six months from the date of insertion.
  • Bridges (fixed or removable).
  • Prosthesis (replacement covered only if the existing prosthesis is at least five years old).
  • General anesthesia (only if performed as part of a covered surgical procedure).
Class IV: Orthodontia
  • Cephalometric X-rays.
  • Diagnostic casts.
  • Active and retention appliances.
  • Active treatment.
The plan will pay 50% of the benefit for orthodontia treatment at the time of the initial treatment and the remaining 50% 12 months later, assuming you continue to be enrolled in the Enhanced Dental Plan. The general plan of treatment for orthodontic care is 18 to 24 months. If the course of treatment is less than 12 months, the plan will make one payment at the time of the initial treatment.