Oral & Vision Health Blog

Preventive, Basic, and Major Services: What’s the Difference?

Regardless of whether you choose a Dental PPO (DPPO) plan or a Dental HMO (DHMO or EPO) insurance plan, knowing your plan’s coverage tiers (the categories your plan groups different procedures into) and the amount of coverage for each tier is the key to understanding how your plan works (and how to save as much money at the dentist as you can). Every dental insurance plan will vary in what procedure it puts in each category – but here are the three tiers and the most common procedures you’ll see in each one.

Preventive Services

This tier contains the most routine dental procedures like cleanings and X-rays. These services tend to be covered more by dental plans – your insurance will probably pay between 70% - 80% of the bill. Services commonly included in this tier include:

  • Cleanings
  • Exams
  • Routine x-rays
  • Fluoride treatments

Most preventive services are covered at least annually. Be sure to check your plan’s preventive services to see if they are covered annually, biannually or quarterly!

Basic Services

The basic services tier includes common dental treatments like fillings and root canals. How much your dental insurance covers will depend on your individual plan – If you have a DPPO plan, your plan will cover around 70% after you meet your deductible. With a DHMO or EPO plan, you will likely pay a copayment for these services. Some of the treatments commonly covered as basic services include:

  • Fillings
  • Root canals
  • Non-routine x-rays
  • Periodontal scaling
  • Root planing

Major Services

Major services include surgical procedures and other complex dental work, like implants and surgical extractions. Major services tend to be the most expensive out-of-pocket, with most DPPO plans covering around 50% after you meet your deductible and DHMO or EPO plan coverage coming with a comparable copayment. Some common major services are:

  • Bridges
  • Complex crowns
  • Dental implants
  • Dentures
  • Braces

Knowing which of these categories your next dental procedure falls into can help you avoid a surprise bill at the end of your visit. It can also make it easier to pick out the right dental insurance for you. If you know you’ll be needing certain dental work this year, make sure you pick a plan that gives you the most coverage for those services! To help, be sure to check out our FREE plan selection tool by clicking the image below.

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