What does a typical dental insurance plan cover?

Dental insurance is structured very differently from medical insurance. Most plans are designed around three procedure categories: preventive, basic, and major, each with its own coverage percentage.

Preventive care typically includes two cleanings per year, periodic exams, bitewing x-rays, and fluoride for children. Most PPO plans cover preventive at 100% with no deductible, because carriers want to keep patients out of expensive procedures later.

Basic procedures cover restorations like fillings, simple extractions, non-surgical periodontal treatment, and emergency exams. These are usually covered at 80% after the deductible has been met. Some plans split fillings into amalgam (silver) and composite (tooth-colored) coverage, with composite sometimes downgraded to the amalgam fee schedule.

Major procedures include crowns, bridges, root canals on molars, dentures, and oral surgery. These are usually covered at 50% after deductible. Orthodontics, when covered, often has its own separate lifetime maximum rather than counting toward the annual maximum.

Cosmetic procedures, dental implants, and adult orthodontics are commonly excluded entirely, although coverage of implants has become more common in newer plans. Coverage details vary widely between plans, which is why verification at the policy level — not just the carrier level — matters so much.