What Does Dental Insurance Cover? Complete Coverage Guide
Learn what dental insurance covers and what it doesn't. Understand coverage levels for preventive, basic, major, and cosmetic procedures plus common exclusions.
How Dental Insurance Coverage Works
Dental insurance works differently from medical insurance. Most plans use a "100-80-50" coverage structure: 100% coverage for preventive care, 80% for basic procedures, and 50% for major procedures. Your annual maximum (typically $1,000-$2,500) caps what insurance will pay per year. Understanding what's covered—and what's not—helps you plan your dental care and budget effectively.
Preventive Care (Usually 100% Covered)
Preventive services are designed to keep your teeth healthy and catch problems early. Most plans cover these at 100% with no waiting period:
- Routine cleanings (prophylaxis): Typically 2 per year
- Periodic exams: Usually 2 per year
- Bitewing X-rays: Usually once per year
- Full mouth X-rays: Every 3-5 years
- Fluoride treatments: For children, sometimes adults
- Sealants: For children's permanent molars
- Space maintainers: For children after premature tooth loss
Basic Services (Usually 70-80% Covered)
Basic services treat common dental problems. These typically have a waiting period of 6-12 months:
- Fillings (amalgam and composite)
- Simple extractions (non-surgical removal)
- Root canals (anterior teeth)
- Periodontal scaling and root planing (deep cleaning)
- Periodontal maintenance cleanings
- Emergency treatment for pain relief
- Oral surgery (simple procedures)
Major Services (Usually 50% Covered)
Major services address significant dental problems. They have the longest waiting periods (12-24 months) and lowest coverage:
- Crowns (caps)
- Bridges
- Dentures (partial and full)
- Root canals (molars)
- Oral surgery (complex extractions, bone grafts)
- Dental implants (many plans don't cover these)
- Periodontal surgery
- Inlays and onlays
Orthodontics (If Covered)
Orthodontic coverage is often separate from regular dental benefits. If your plan includes it:
- Typically 50% coverage
- Lifetime maximum (usually $1,000-$3,000) separate from annual max
- Longest waiting period (12-24 months)
- May only cover children under 18 or 26
- Traditional braces usually covered
- Clear aligners (Invisalign) may or may not be covered
- Retainers typically covered as part of treatment
What Dental Insurance Typically Doesn't Cover
Most dental plans exclude these services entirely:
- Cosmetic procedures (veneers, teeth whitening, cosmetic bonding)
- Dental implants (many plans exclude or limit coverage)
- Adult orthodontics (some plans only cover children)
- TMJ/TMD treatment
- Pre-existing conditions (immediate coverage may be denied)
- Services above the annual maximum
- Treatment started before coverage began
- Procedures considered "not necessary" by the insurer
Frequently Asked Questions
What does dental insurance cover?
Most dental insurance covers preventive care at 100% (cleanings, exams, X-rays), basic services at 70-80% (fillings, simple extractions), and major services at 50% (crowns, bridges, dentures). Coverage is subject to annual maximums and waiting periods.
Does dental insurance cover implants?
Many dental plans don't cover implants, or provide limited coverage. If covered, implants are typically classified as major services (50% coverage) with long waiting periods. Some plans cover the crown but not the implant itself. Always verify coverage before treatment.
Does dental insurance cover root canals?
Yes, most plans cover root canals. Front teeth root canals are often classified as basic services (80% coverage). Molar root canals are typically classified as major services (50% coverage) due to their complexity.
Does dental insurance cover teeth whitening?
No. Teeth whitening is considered cosmetic and is excluded from virtually all dental insurance plans. You'll need to pay out-of-pocket for professional whitening treatments.
Does dental insurance cover braces?
Some plans include orthodontic coverage, but it's often a separate benefit with a lifetime maximum. Adult orthodontics may not be covered even if children's braces are. Check your specific plan for orthodontic benefits.
How much does dental insurance pay per year?
Most dental plans have an annual maximum of $1,000-$2,500 per person. This is the most insurance will pay for covered services in a plan year. You're responsible for any costs above this amount.
Not Sure What Your Dental Insurance Covers?
Upload your treatment plan and insurance card, and we'll help you understand exactly what's covered, what you'll pay, and how to maximize your benefits.
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