Plan Maximums

The TRICARE Dental Program has some limits on how much it will pay per person.

The following applies to your plan maximum:

• Only the allowed fee or your dentist’s actual charge, if lower
• This doesn’t include your cost-shareA percentage of the total cost of a covered health care service that you pay.
• Also, some dental services don’t apply to your maximum
• You can download the TRICARE Dental Program Benefit Booklet for a complete list

Annual Maximum for Non-Orthodontic Services

• $1,500 per person, per contract year 
• Payments for certain services don’t apply
• In 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, we pay for any valid costs in excess of the allowed amount up to the billed charge. This is for all enrollees except Selected Reserve and IRR family members, IRR (other than special mobilization category) members, and those who aren’t command sponsored.

Lifetime Maximum for Orthodontic Treatment

• $1,750 per person
• Orthodontic diagnostic services apply to the annual maximum, not the lifetime maximum

Annual Maximum for Accident Care

• $1,200 per person, per contract year
• After you meet your accident care maximum, additional costs apply to the annual maximum