Dental Plans: What Do They Cover?

Date ,   Published by dental.net

Dental plans are a good thing to have around. Sometimes, we get caught up in taking care of our body’s health, that we forget that our dental health is just as important. Our teeth and gums are integral to our well-being and they are irreplaceable. Dental procedures, especially major ones, can be quite expensive. Dental plans can help you reduce the out-of-pocket costs of taking care of your teeth.


Many insurance plans don’t cover dental work. So, you must get a separate dental plan to take care of your (and your family’s) teeth and gums. Most dental plans cover our basic needs to take care of our oral health and is usually designed to take a care of a portion of our dental care needs.  Not all procedures will be covered by dental insurance, and most health insurance companies will cap the amount of dental work you can do with a fixed amount, around $1000-$2000 dollars, depending on your company. They will also have a Usual, Customary and Reasonable (UCR) fee guide

Let’s take a look at the different procedures that your basic dental plan can cover, and up to how much.

Preventative Care:
For PPO (preferred provider organization) dental plans (the type you get through your employer’s insurance benefits) will cover preventative care. These are the procedures that keep you healthy and you must undergo in order to prevent you from needing major procedures later on. Most will cover once or twice a year teeth cleanings, examinations and check-ups, up to 100 pecent. Dental sealants (clear plastic coating to prevent tooth decay), x-rays and fluoride treatments can be covered 80 – 100 percent of the total cost.

Basic Care:
At the next level, dental plans can cover some basic care. These are procedures that are routine, and are fairly common with people who aren’t as digilent with taking care of their teeth as they should be. Extractions (removal of the teeth) are the most common basic procedure, as well as fillings. Root canals can also be covered under basic care. These procedures can be covered partially, up to 80 percent

Major Care:
Big procedures which need a lot of work and expertise can be considered major care. Crowns and caps are considered major care – these are dental fittings, shaped like a tooth to cover a tooth above the gumline. If a tooth is too severely word down or broken, (due to accidents or even poor care) it may require fitting a crown. A bridge basically fills in the place where there is missing teeth between two crowns, while full and partial dentures are false teeth which replace missing teeth. These are all major procedures which may only be covered up to 50 percent by your dental plan

What’s not covered?
Basic care, including root canals, extractions, and fillings are usually covered at the rate of 80 percent. Major care such as crowns or caps, bridgework, and full or partial dentures as well as periodontal (gum) care are often covered at 50 percent Many insurance companies have a yearly maximum amount that they will cover of $1000.

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