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We’ll be the first to admit: insurance is complicated. (Though we’re working hard to change that.) And dental insurance is no exception. After generating your free quote, you might be thinking — what does “periodontal maintenance” mean? What about waiting periods? And is your twice-yearly cleaning really at no additional cost? (If you visit an in-network dentist, it is!)
But dental insurance is actually pretty simple. Most plans follow a 100-80-50 coverage structure. That means preventive care, which includes your twice-yearly cleanings (and your x-rays and fluoride treatments that come with it) and brush biopsy, which screens for oral cancer, is 100% covered. Then your minor dental care costs are 80% covered, and your major dental care costs are 50% covered.
To keep things simple, we’ll start by explaining what minor procedures are covered by dental insurance and what to expect if you need one done.
What is considered a minor dental procedure?
Some dental insurance providers will also call these procedures “basic services,” but they mean the same thing — common services that don’t usually require a lot of downtime or intensive care. If you see the following procedures listed on your dental insurance benefits (or hear about them from your dentist), here’s what they mean:
Radiographs/diagnostic imaging: These x-rays are for routine care or to diagnose a condition. They’re different from preventive x-rays you might receive during your twice-annual cleaning appointment.
Sealants: Sealants are plastic resins that bond and harden in the grooves of your teeth. This creates a smooth surface that’s less likely to develop plaque and cavities. Typically, children get sealants after their permanent teeth come in — but adults can get their teeth sealed (and re-sealed) too.
Periodontal maintenance: Also known as a deep cleaning, this type of care is for those with existing dental problems like periodontitis (or gum disease). Without proper maintenance, periodontitis can cause teeth to loosen or even teeth loss.
Minor restorative services: A broad term, but it refers to filling a (gulp) cavity. These can be white (which are more common today) or silver fillings, which are used to restore tooth damage by bringing the tooth back to its normal shape and function.
Simple extractions: This refers to when a tooth needs to be removed because of decay or other reasons. Your dental insurance will typically include local anesthesia and post-operative care with the overall cost. Simple extractions don’t take much time at all, but will usually require a day to recoup (plus, it’s a good excuse to stock up on ice cream).
How much will dental insurance cover for your minor procedures?
Dental insurance pays a portion of the cost of preventive services like cleanings, minor dental care like fillings and extractions, and major care like crowns and dentures. Remembering the 100-80-50 coverage structure, dental insurance will cover 80% of your minor dental care costs as long as you’re visiting an in-network dentist.
To get the most value out of your dental insurance plan, it’s important to make those twice-yearly visits a priority — so you can catch problems early before they become costly. Plus, there are a few other great benefits too:
Your dental hygienist can remove stains (like from your morning coffee habit) that discolor your teeth.
Your dentist can detect early stages of oral cancer, signs of broken fillings, and fractures.
Do you grind your teeth? Experience jaw or neck pain? Your dentist will assess your bite alignment to see any changes and offer solutions to reduce any pain you’re having.
Your dentist can detect signs of other health-related issues, like diabetes or vitamin deficiencies.
Let’s be honest — that super-clean feeling is worth mentioning on this list.
Why enroll in dental insurance?
Enrolling in dental insurance can save you — and your wallet — from a surprise dental bill by covering some of the costs. But it can also help keep you on top of your overall health and wellness, too. Since (with most plans) you pay $0 for routine cleanings twice a year, why wouldn’t you go?
You can enroll in dental insurance at any point during the calendar year — so there’s no need to wait for Open Enrollment! However, some plans might require a waiting period that can range from six months to a full year before any standard work (like some of the minor procedures listed above) can be done. So if you’re thinking about holding out on dental insurance until that back molar starts bothering you — think again.
Almost everyone has to get a cavity filled or a tooth extracted at some point. And while it might not be an ideal way to spend a weekday, with dental insurance, saving 80% on the high cost of dental care is sure to make you find a smile. (Ice cream helps, too.)