Dentistry
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Updated on December 29, 2022
7 min read

Dental Insurance Coverage

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What Does Dental Insurance Cover?

Dental insurance reduces the cost of dental care and helps people maintain good oral health throughout their lives. Insurance allows people to spend less out of pocket on needed procedures and catch signs of oral disease early.

Most dental plans cover some portion of preventive treatments, restorative procedures, and orthodontic treatment.

According to Cigna’s website, many insurance companies offer a “100-80-50” plan, which covers:

  • 100 percent of regular preventive care, such as teeth cleanings, dental exams, and fluoride treatment.
  • 80 percent of basic procedures, such as dental fillings, extractions, and root canals.
  • 50 percent of major procedures, such as bridges, implants, and crowns.
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What Does Dental Insurance Not Cover?

Dental insurance does not cover cosmetic dental procedures, also known as esthetic dentistry.

Cosmetic or esthetic procedures are never covered by insurance because they are not considered “medically necessary.” These include teeth whitening and veneers. Both treatments improve the appearance of the teeth but don’t medically restore damaged teeth.

Note that if a procedure that provides cosmetic benefits is considered medically necessary, it may still be covered by your dental plan. This may include orthodontic treatment, for example. 

While orthodontic treatment may improve your appearance, it may not necessarily be considered purely cosmetic by insurance.

Did you know dental savings plans are an affordable insurance alternative? Learn everything you need to know about dental savings plans.

Insurance Terms to Know

Premium

The premium is the amount you pay monthly for an insurance plan.

Deductible

The deductible is the out-of-pocket cost patients pay before treatment. Insurance providers pay for part or all of the expenses after treatment, and patients get reimbursed.

Copayment

A copayment, also called a “copay,” is the shared amount a patient pays for treatment. This amount is usually a percentage of the dentist’s fee.

Dual Coverage

Dual coverage means more than one dental insurance plan covers the patient’s treatment.

Treatment Limitations

Depending on your insurance plan, procedures can only be completed a certain amount of times per year.

For example, most insurance companies typically only cover oral exams twice yearly (every 6 months). So if more exams are necessary, insurance will not cover them.

Also, some policies do not cover pre-existing dental conditions, such as missing teeth that were lost or damaged before receiving insurance.

A dental insurance plan will also have an annual maximum. This is the maximum amount of money that your plan will provide in a given year. Once you’ve gone over that amount, you’ll have to pay the full cost of any additional procedures.

Dental Coverage: Preventive Care

Preventive dental care is covered 100 percent by most insurance plans (after the deductible is met). For example, common treatments include:

Dental Exams

During oral exams, dentists examine the mouth for signs of cavities, gum disease, and other related conditions.

Routine Teeth Cleanings (twice a year)

During teeth cleanings, a dentist removes hard-to-reach plaque and calculus from the surfaces of teeth and between teeth.

Dental X-rays (once a year)

X-rays aid in diagnosing oral diseases that are not visible during a normal dental exam.

Fluoride Treatment (in-office)

Fluoride is a mineral that helps prevent tooth decay and strengthens enamel. Small traces of fluoride are in tap water, toothpaste, mouthwashes, and professional dental materials.

Tooth Sealants

Sealants are thin coatings that form “physical barriers” on the pits and fissures of teeth that help prevent cavity formation early on. They are usually recommended for children but can be done in adults. 

Dental Coverage: Basic Services

With standard policies, insurance covers minor restorative dental procedures (80 percent covered after deductible). These procedures include:

Cavity Fillings

Dental fillings are used to fill minor dental cavities (decaying teeth).

Emergency X-rays

Any additional X-rays (more than twice a year) may not be fully covered by insurance.

Emergency Dental Care

Emergency dental care covers mouth injuries resulting in knocked out, fractured, or damaged teeth.

Tooth Extractions

Teeth sometimes need to be non-surgically or surgically removed due to severe decay, injury, or disease. Surgical tooth removal may be partially covered.

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Dental Coverage: Major Services

With standard policies, insurance only partially covers invasive restorative procedures (50 percent covered after deductible). In particular, these procedures include:

Root Canal Treatment

Root canal therapy restores infected dental pulp in the roots of teeth and also relieves dental pain.

Scaling and Root Planing

Scaling and root planing involves the removal of plaque and calculus (hardened plaque) above and below the gumline.

Dental Crowns

Crowns are placed over chipped, broken, or damaged teeth. They can also cover weak teeth, typically caused by severe decay.

Dental Inlays and Onlays

Inlays and onlays are indirect restorations, which means they are made outside of the mouth in a dental laboratory. They are typically used when a patient’s cavity is too large for a filling.

Dental Bridges

A dental bridge is a fixed restoration that replaces one or more missing teeth in a patient’s dental arch.

Dentures

Dentures are artificial substitutes that replace some or all of a patient’s natural teeth and surrounding tissues.

Dental Restoration Repairs

Repairs are covered by most insurance plans if they are needed more than 12 months after placement.

Oral Surgery

Many oral surgeries are covered by insurance. This includes surgical tooth extractions, such as impacted wisdom teeth removal.

Dental Anesthesia

Anesthesia alleviates pain and discomfort during a dental procedure. Local anesthetic (limited to one area) is used for more minor procedures. Sedation may be used for more extensive treatment or treatment in those who can’t tolerate dental procedures with only local anesthetic.

How Much Does Dental Insurance Cost?

Monthly premiums for dental insurance can vary widely. Some plans are more comprehensive than others, and even the same provider may offer a different set of plans for each state.

As a general estimate, you can expect to pay:

  • $22 a month or less for a very basic plan that only covers preventive care
  • $35 a month or more for a provider’s most comprehensive plan

Many providers offer intermediate plans, which cover more than just preventive care but offer less than the maximum available coverage. Your monthly premium for a plan like this will fall in the middle.

Another factor to consider is orthodontic insurance, which some providers offer as a separate package with its own deductible.

Several dental assistance programs can help those with low income.

Popular Dental Insurance Providers

Delta Dental

Delta Dental is the largest provider of dental insurance in the United States. They offer a range of plans, from the most basic to more comprehensive.

This provider consists of 39 independent companies, which cover different states or groups of states. The specific plans and rates offered can differ greatly depending on your location.

Cigna

Cigna is a multinational healthcare and insurance company and another common dental insurance provider. They provide multiple dental plans, including ones bundled with vision and hearing coverage.

This provider isn’t available in every state.

Aetna

Aetna is a major health and dental insurance provider. Since 2018, it has been owned by CVS Health, which also owns CVS Pharmacy. They offer a variety of plans and a wide network of care providers.

Aflac

Aflac (American Family Life Assurance Company of Columbus) provides dental insurance, including plans that combine dental, vision, and hearing coverage. They also offer deductibles that decrease over time.

Aflac dental insurance may not be available in every state, and they don’t list all of their pricing information online. You’ll have to request a quote over the phone or through their website.

Humana

Humana is one of the largest health insurance companies in the United States. Like Aetna, they have a large nationwide provider network. They offer several dental plans without waiting periods.

UnitedHealthcare

UnitedHealthcare is another major national health insurance provider that offers dental insurance underwritten by its subsidiary, Golden Rule Insurance Company. Like Humana, they offer no-waiting-period plans.

Summary

Dental insurance allows people to spend less out of pocket on needed dental care. Dental insurance plans often distinguish between three kinds of procedures:

  1. Regular preventive care, such as routine cleanings and exams
  2. Basic procedures, which include fillings and root canals
  3. Major procedures, like dental implants and crowns

Policies vary, but preventive care is the most likely category to receive full coverage. Basic procedures may have substantial partial coverage, while major procedures tend to have the least coverage.

Dental insurance plans also won’t cover elective cosmetic procedures, like veneers. It may cover orthodontic treatment, however, which can have cosmetic and health benefits.

Find out what dental insurance providers are available in your area and compare to find the best plan for your needs.

What’s Next?

Discover how you and your family can save money on common dental procedures with a dental discount plan.

Or call DentalPlans to speak with a representative about which plan is right for you.

Last updated on December 29, 2022
6 Sources Cited
Last updated on December 29, 2022
All NewMouth content is medically reviewed and fact-checked by a licensed dentist or orthodontist to ensure the information is factual, current, and relevant.

We have strict sourcing guidelines and only cite from current scientific research, such as scholarly articles, dentistry textbooks, government agencies, and medical journals. This also includes information provided by the American Dental Association (ADA), the American Association of Orthodontics (AAO), and the American Academy of Pediatrics (AAP).
  1. Hollins, Carole. Basic Guide to Dental Procedures. John Wiley & Sons, Inc., 2015.
  2. Individual CIGNA Dental Choice. Cigna Corporation.
  3. What Dental Insurance Covers.” Delta Dental.
  4. Dental Insurance Plans for Individuals.” Aflac.
  5. How Much Does Dental Work Cost?” CostHelper Health.
  6. Dental Coverage in the Health Insurance Marketplace.” HealthCare.gov.
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