Cost-Shares

You'll pay cost-shares for covered dental services, as well as your monthly premiums. Your cost-shares depend on:

• Your sponsor's pay grade and 
• Where you live, the CONUS50 United States, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands Service Area or the OCONUSAreas outside of the 50 United States, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands Service Area.

Covered Services	CONUS Service Area		OCONUS Service Area
	Pay Grades E-1 - E-4	Pay Grades E-5 and above	Command-Sponsored Beneficiaries1
Diagnostic	0%	0%	0%
Preventive2	0%	0%	0%
Sealants (Sealants included at 0% after May 1st, 2017)	20%	20%	0%
Consultation/Office Visit	20%	20%	0%
Post-Surgical Services	20%	20%	0%
Basic Restorative	20%	20%	0%
Endodontic	30%	40%	0%
Periodontic	30%	40%	0%
Oral Surgery	30%	40%	0%
General Anesthesia	40%	40%	0%
Intravenous Sedation	50%	50%	0%
Miscellaneous Services(occlusal guard, athletic mouth guard)	50%	50%	0%
Other Restorative	50%	50%	50%
Implant Services	50%	50%	50%
Prosthodontic	50%	50%	50%
Orthodontic3	50%	50%	50%

1. Doesn’t apply to Selected Reserve and Individual Ready Reserve members (other than Special Mobilization Category) and their families. They will pay CONUS cost-shares.
2. We fully cover space maintainers for posterior teeth for patients under age 19. We cover them at a 20% cost-shareA percentage of the total cost of a covered health care service that you pay. for patients under age 19 when replacing anterior teeth only. We cover sealants at 20% as noted above.
3. Available for enrolled family members.  We cover:
   • Children up to age 21 or 23, based on your student status: >>Learn more
   • Spouses up to age 23
   • National Guard/Reserve sponsors up to age 23

Your dental coverage has specific limits and exclusions. You can get details at TRICARE Dental Program Benefit Booklet.