Special Health Care Needs Benefit: Additional benefits when your patient needs them

Effective January 1, 2024

For 6.5 million people in the U.S. with intellectual or developmental disabilities, oral health care can be inaccessible or overwhelming.

Effective January 1, 2024, Delta Dental of New Jersey and Connecticut is expanding our coverage for group dental plan members for patients with special health care needs—individuals with cognitive, physical, significant behavioral issues, or other potential barriers for treatment.

• Additional dental examinations and/or consultations that can be beneficial prior to treatment to help patients learn what to expect and what is needed for a successful dental appointment.
• Up to four total dental cleanings in a benefit year.
• Treatment delivery modifications (including anesthesia) necessary for dental staff to provide oral health care for patients with sensory sensitivities, behavioral challenges, or other barriers to treatment.

Before rendering services, please check the member’s eligibility on our online dentist portal to verify coverage of our enhanced special needs benefit and other necessary procedures.

 Claim Submission

Simply add D9997 to an eligible member’s initial claim to trigger the enhanced benefit. Subsequent submissions of D9997 should only occur when necessary, as defined in the ADA’s current CDT definition for this code.

With support from the Delta Dental Foundation, Penn Dental Medicine has established a free continuing education course aimed at building awareness of the barriers to equitable oral health care for individuals with disabilities and developing competency to provide oral health care to this vulnerable population.

View Course

How do I learn more?

Learn how this benefit works.

Register for a free CE course offered by the University of Pennsylvania and Delta Dental.