What Procedures are Usually Included in Dental Plan Coverage?

In general, most dental insurance policies only cover treatment that is considered medically necessary. This often includes preventive dental treatment, such as regular checkups and cleanings. Routine dental work that focuses on keeping the teeth and gums in good shape is also often covered, and usually includes fillings, tooth extractions, and crowns. Other types of treatments may only be partially covered, such as root canals, dentures, and braces. Dental plan coverage usually depends on the chosen plan, with the more expensive policies usually covering more procedures.

Even the most basic plan usually covers regular preventive care. For example, checkups are usually covered under the typical plan since most providers realize that preventing tooth problems is less expensive for them than treating major issues that develop after a lack of routine care. Therefore, checkups and cleanings are usually entirely paid for, and should be sought at least annually. The usual checkup often involves maintaining the health of the gums, not just the teeth, as gingivitis and receding gums may be easily treated if caught early. Fluoride treatment may also be offered to help protect the gums and teeth, so this treatment is usually paid for by insurance.

Dental plan coverage often also extends to routine care when an issue is discovered at a checkup. For example, when a cavity is found, the filling is usually paid for by insurance. Tooth extractions are also usually covered when they are necessary for the health of the patient's mouth. Small procedures, such as filling in a chipped tooth, are frequently included in dental plan coverage, as well. Crowns, tartar removal, and tooth polishing are also usually included in the category of routine dental procedures, so they are typically paid for, at least in part, by insurance.

In most cases, mouth surgery is only partially covered by insurance unless the plan is particularly comprehensive, in which case the premium is likely quite expensive. For example, most patients pay out of pocket for a root canal, though some affordable plans may pay for a portion of it, if it is medically necessary. The typical dental plan coverage usually includes at least partial payment of dentures, and it is usually advised that older patients who anticipate needing these in the near future opt for a plan that covers the entire cost of dentures. Typical dental plan coverage pays for at least most of the cost of braces for children, but many do not extend coverage to braces for adults.