Implants · Updated 2026-09-08 · 5 min read

Which dental insurance plans have no missing tooth clause?

The named plans that state they have no missing tooth clause — federal, state-employee, military and commercial — and how often plans answer that the clause does not apply.

Plans with no missing tooth clause are the majority, and several name themselves. The TRICARE Dental Program states the missing tooth exclusion does not apply; Delta Dental's federal FEDVIP plan removed its clause effective 1 January 2025; Delta Dental of Washington says in its provider FAQ that its plans have none; the HealthChoice Oklahoma state-employee plan says the same in its handbook; and the Delta Dental of California small-business PPO and Delta Dental of Minnesota "Evolution" plans market the absence as a feature. On those plans the first bridge (D6240, D6740–D6752), implant (D6010), partial (D5211/D5213) or denture (D5110/D5120) for a tooth lost before coverage is not blocked by the clause. As of September 2026, of 10,873 plan verifications Kaylie ran in a single week of July 2026, 9,262 (85.2%) answered that the clause does not apply.

What we measured

The first row is every plan verification Kaylie ran in that week across all carriers where the plan answered either way — one patient's benefit check each, so a plan can appear more than once. The Delta rows are member-company verifications from July 2026; only the Kansas row is known to cover 73 distinct plans. No practice, employer or patient is identified. This is Kaylie's own verification data, not a published market statistic — there is no industry figure for how many dental plans carry the clause.

What these plans' own policies say

The military program: "The missing tooth exclusion does not apply." (TRICARE Dental Program Benefits Reminder / Provider Fast Facts.) The program does keep a separate rule that prostheses initiated before the effective date are not payable.

The federal employees' plan: "The Missing Tooth Clause, which previously excluded coverage on a tooth missing prior to the enrollment effective date, will no longer apply and has been removed from the brochure." (Delta Dental FEDVIP Plan Brochure 2025, "How We Have Changed for 2025".) GEHA's federal plan is in the same position — its Connection Dental Federal FEDVIP brochures for 2023, 2025 and 2026 carry no missing tooth exclusion, only the rule that prostheses initiated before the effective date are not payable — while GEHA's commercial Connection Dental Plus product does carry a full exclusion.

A member company, flatly: "Is there a missing tooth clause? — No, there is no missing tooth clause." (Delta Dental of Washington Provider FAQ.)

A state-employee plan, in a one-line note in the major-services section: "Note: HealthChoice does not have a missing tooth clause." (HealthChoice Oklahoma Dental Plan Handbook 2025.)

Two commercial products that sell the absence: "No missing tooth exclusions for teeth lost prior to this coverage" (Delta Dental of California 2025 Small Business Plans brochure) and a "No Missing Tooth Clause" row marked Yes across all three tiers of the Delta Dental of Minnesota PPO Plus Premier "Evolution" Plans 2026 comparison table.

Children on an ACA pediatric dental benefit are usually exempt even where the plan has a clause. DentaQuest's Virginia PPO excludes "Services related to a tooth missing at the effective date of coverage for persons age 19 and over" (DentaQuest Virginia PPO Benefit Summary 2026) — the age gate is the exemption. Principal's missing tooth provision likewise does not apply to pediatric essential benefits.

Some Anthem plans waive it outright — one Essential Choice PPO Premier summary states "no waiting period for replacement of congenitally missing teeth or teeth extracted prior to coverage" — and some Cigna groups buy the limitation out entirely so a pre-existing gap is covered at the full Class III benefit from day one.

Why it depends on the plan

None of this is a carrier-level fact. The clause is bought or declined in the contract — a federal program, a state plan, a product line, or an employer group. Across 4,990 employer groups in Kaylie's verified answers in August 2026, all the plans in one group gave the same missing-tooth answer 97.9% of the time, while knowing only the carrier predicted it 84.2% of the time.

The same carrier can sit on both sides in the same year. Delta removed the clause from its federal employees' plan in 2025, kept it on its veterans' program, and a Delta company added one to its individual PPO Premium plans on 1 August 2025 outside California.

What to do

Do not shop this list for a patient. Verify the plan in front of you, ask for the clause by name, and record the answer against the employer group in the practice management system — the next patient from that group will almost always have the same answer.

Where the plan has no clause, check what remains before quoting: the replacement frequency limit, the annual maximum, whether the tooth is congenitally missing (a separate exclusion that often survives), and whether a large edentulous span triggers an alternate benefit of a removable partial. "No missing tooth clause" answers one question, not the estimate.

Numbers last refreshed September 2026.

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