Which dental procedures are covered?

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Most dental insurance policies cover preventative care, routine dental work, and some other treatments, but coverage varies depending on the plan chosen. Basic plans usually cover regular checkups and cleanings, while more expensive policies cover more procedures. Surgery and some treatments may only be partially covered.

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

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

Dental plan coverage often extends to routine care as well when a problem is discovered at a checkup. For example, when a cavity is found, insurance typically pays for the filling. Tooth extractions are also typically covered when necessary for the health of the patient’s mouth. Small procedures, like filling a chipped tooth, are also often covered by a dental plan. Crowns, scaling, and dental polishing also often fall under the category of routine dental procedures, so they are usually paid for, at least in part, by insurance.

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

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