Oral & Vision Health Blog

What’s (typically) covered on my dental plan – and what’s not?

Many people don’t leave the dentist with a smile on their face for one reason – their bill. It’s not reassuring to find that the work done on your mouth is going to put a hole in your pocket when you thought it would be covered by your insurance. In today’s fast paced world, we have too many things to worry about – sometimes we just want the bottom line. So we’d like to give you a little guidance on what is (typically) covered on your dental plan and what’s not.

Types of Dental Care 

There are seven basic areas of dental care that plans cover. They are as follows:

  1. Preventive Care– includes your bi-annual cleanings and office visits, among other basic dental procedures.
  2. Restorative Care– require more work and usually require some form of out-of-pocket payment. Examples of restorative procedures could be a crown or filling.
  3. Endodontics– procedures that will result - in most cases - with a fee. Root canals are one of the many endodontics procedures which plans cover.   
  4. Oral Surgery– includes procedures such as tooth removals.
  5. Periodontics– scaling and root planing (also known as a deep cleaning) is the most common one, but there are others.
  6. Prosthodontics– mostly used for the elderly who are in need of dentures and/or bridges.
  7. Orthodontics– sometimes referred to as “cosmetic dentistry” procedures, braces, retainers and other teeth correctors fall into this category.

These areas on dental policies can be grouped into three areas based on cost: preventive, basic and major.

Areas of Dental Coverage
  • Preventative- Most plans cover 100 percent of preventive care procedures. Routine cleanings and X-rays are two examples of preventive care treatments in this area. Other measures of dental work usually have a co-pay associated with them.
  • Basic- They are usually covered under most dental insurance plans – but almost always at a lower amount. Extractions, deep cleanings and cavity fillings are a few procedures that would be considered a “basic procedure”. They are typically covered anywhere from 60 - 80 percent by your dental plan.
  • Major- The most costly processes, such as bridges, crowns and dentures would be classified as “major procedures”. They require a greater out-of-pocket cost as opposed to basic and preventive procedures. Usually, these procedures are covered 50 percent or less by your dental plan.  

The numbers given for each group of procedures are estimates and will vary based on the richness of your dental plan. Most dental PPO plans have an average deductible of $50 and a maximum annual benefit of $1,000 to $1,500. Depending on your insurance carrier, you may be able to roll over your unused annual maximum to the following year. Check to see if there are other levels of annual maximums available if you know you may be needing an extensive amount of dental work. Many individual plans are customizable to your dental needs – you just need to make sure you know what those are when you go shopping!

Helpful hint: when looking to purchase or enroll in a dental plan, be sure to compare the various co-pays for the services you use most. This ensures that the plan you pick will give you the best care at the lowest price.

If you have questions, or are unsure of what you should be looking for in a dental plan, we can help! Call us for a consultation or click the button below to schedule an appointment with one of our agents. They will help you get the perfect plan for your needs.


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