Preventive, Basic, and Major: How Does Dental Insurance Work?

By Tim Fitzgerald on Mar 23, 2021 @ 11:30 AM

Knowing your plan’s coverage tiers and the amount of coverage for each tier is the key to understanding how your plan works. Knowing the types of dental services your plan covers and how they are covered is critical. This is true whether you choose a Dental PPO (DPPO) plan or a Dental HMO (DHMO or EPO) plan. Every dental insurance plan will vary in what procedures they put in each category.

We will now go over the three tiers of dental coverage and the most common procedures in each one. These categories also help you understand how much you will pay based on your plan.

Preventive Services

This tier contains the most routine dental procedures like cleanings and X-rays. Dental plans cover these services more, but your insurance will probably pay between 70% and 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. 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 plan – If you have a DPPO plan, your plan will cover around 70% after you meet your deductible. You will likely pay a copayment for these services with a DHMO or EPO plan. Some of the treatments commonly covered as essential 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 standard 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 choose the right dental insurance. If you know you’ll need specific dental work this year, pick a plan that gives you the most coverage for those services! To help, check out our FREE plan selection tool by clicking the image below.