11 things you didn’t know dental insurance covers
Dental insurance generally covers a portion of the cost of range of dental services from routine preventive care to dental surgery, including oral exams, cleanings, X-rays, filings, extractions, oral surgery, root canals, crowns, and implants. It might also cover orthodontics, periodontics, and prosthodontics, such as dentures.
Dental procedures at most dental insurance companies are grouped into three main categories: preventive, basic and major. Many plans cover preventive care at 80% to 100%, basic procedures at 50% to 70%, and major services, such as surgery, at 50%. However, coverage and costs can vary depending upon the plan level you select. Many plans have caps on what they will pay during a plan year, which can increase the longer you have the plan.
There is no standard classification among insurance companies for what services are considered preventive, basic or major and insurance coverage varies. When comparing dental insurance plans, it’s important to compare what services each insurance company classifies as preventive, basic or major and what their coverage is for those classifications.
1. Dental X-rays
X-rays are an important diagnostic tool that dentists rely on. Most of the time when you first see a new dentist, they will take a set of X-rays before examining your teeth. X-rays help dentists understand what’s going on with your teeth and spot any potential problems like cavities that may not be visible from the surface. Typically X-rays are done just once every two years unless you have a specific problem that the dentist needs to check with an X-ray. Most dental insurance companies will pay the full cost of a set of new X-rays every two years. If you switch dentists in that time you will need to have your original X-rays forwarded to your new dentist.
2. Teeth cleanings
It used to be recommended that you have your teeth cleaned just once a year but now it’s standard practice to get your teeth cleaned twice a year. Most dental insurance plans will pay the full cost of two cleanings per year, although if you need a deep cleaning you may have to pay part of the cost because it’s more expensive than a standard cleaning.
You also may need to pay the full cost of a cleaning if you need to have cleanings done every couple of months instead of every six months. Diabetics and people with other health conditions may need to have dental cleanings done more frequently than every six months. If you have a medical need for frequent teeth cleanings your dental insurance company may cover some of the cost, but that varies by insurance company and by plan. In general dental insurance will cover two cleanings per year that are done six months apart.
3. Dental exams
It’s recommended that you see the dentist for regular visits, usually once or twice per year. Many insurance companies will foot the bill for both of the recommended yearly visits, although you might have to have a certain amount of months between visits in order for the exam to be covered.
4. Dental sealants
Dental sealants are often recommended for children. As their permanent teeth come in, applying a sealant can help stop tooth decay before it starts and protect those teeth from damage. Fluoride treatments are also recommended for kids, especially in areas where the drinking water isn’t fluoridated, and can also sometimes be recommended for adults too. Dental insurance plans usually cover the full cost of sealants and fluoride treatments because they are considered to be preventive treatments.
Basic dental care
5. Tooth extractions
If you need to have a tooth removed, dental insurance may cover about 50% of the cost of a tooth extraction after a six-month waiting period, although there may be limits in certain plans that cap the amount that will be paid for extractions of broken or impacted teeth. You also may be limited to one or two extractions per visit, which would mean you’d have to have multiple visits if you need several extractions.
Fillings are one of the most common dental procedures. The price of the filling depends on what type of filling that you get. Silver amalgam fillings tend to be less expensive than white porcelain fillings. Dentists typically recommend getting white porcelain fillings only for front facing or visible teeth and getting the silver amalgam fillings on back teeth. Dental insurance may pay for 50% to 70% of the cost of fillings after a six-month waiting period, but you may have to pay more of the cost if you want porcelain fillings. Some insurance companies will only cover the cost of the amalgam fillings which means you would pay the difference in cost between the two types of fillings out of pocket.
Major dental procedures
7. Root canals
Root canals may be necessary when you have a broken or damaged tooth. The cost of a root canal varies depending on the location of the tooth, from $762 for a front tooth, $879 for a premolar, and $1,111 for a molar.1 Much of the cost of the root canal depends on which tooth is damaged or broken. A root canal on a front tooth will be more expensive than a root canal on another tooth. Having dental insurance help you cover the costs. Dental insurance may cover 50% of the cost of the root canal after a 12-month waiting period.
8. Dental crowns
Crowns are used in conjunction with root canals and implants to restore the appearance of teeth. The cost of a crown on average can range from $600 to $1,500 per crown2 depending on the location of the crown. Usually dental insurance may cover up to 50% of the cost of a crown after a 12-month waiting period.
9. Dental bridges
Dental bridges are used to provide support to surrounding teeth when a tooth is missing and to hide gaps caused by missing teeth. In order to stabilize the teeth on either side of the missing tooth a metal bridge structure is built on the two teeth surrounding the missing tooth to keep them strong and to keep them from shifting position. Dental insurance may pay for up to 50% of the cost of a bridge after a 12-month waiting period.
10. Dental implants
Dental implants are the best choice for replacing missing teeth. They are highly recommended by dentists because they function just like real teeth. You can bite and chew normally with a dental implant and they restore the appearance of your teeth while keeping the teeth on either side from shifting or weakening. Dental insurance may cover 50% of the cost of each implant after a 12-month waiting period.
11. Braces or aligners
One of the most often asked about dental procedures is braces or aligners. They’re expensive and can cost anywhere from $3,000 to $10,000 depending on your unique situation and what type of braces or aligners your dentist recommends. Insurance may pay up to 50% of braces after a 12-month waiting period.
The cost of all of these typical dental procedures may seem overwhelming. But just remember that there are ways of making dental care more affordable. Having dental insurance can help significantly lower your costs for basic procedures. Don’t let the cost of dental care keep you from getting the care you need.
Links to external sites are provided for your convenience in locating related information and services. Guardian, its subsidiaries, agents and employees expressly disclaim any responsibility for and do not maintain, control, recommend, or endorse third-party sites, organizations, products, or services and make no representation as to the completeness, suitability, or quality thereof.
Brought to you by The Guardian Life Insurance Company of America (Guardian), New York, NY. Material discussed is meant for general illustration and/or informational purposes only and it is not to be construed as tax, legal, investment or medical advice. This is not dental care advice and should not be substituted for regular consultation with your dentist. If you have any concerns about your dental health, please contact your dentist's office.
1. https://www.colgate.com/en-us/oral-health/procedures/root-canals/what-root-canals-cost-why-cost-varies-0217 (Last accessed May 2020)
2. https://www.investopedia.com/ask/answers/113015/does-dental-insurance-cover-crowns.asp (Last accessed May 2020)