Dental insurance plans: Covered procedures -
Preventive, Basic and Major.
Dental insurance plans typically classify dental services as Preventive, Basic or Major.
You may be unfamiliar with the terms Preventive, Basic and Major dental services. These are categories that dental insurance plans typically use to identify the level of benefits that they provide for different covered dental services. On this page we've attributed coverage levels and procedures to each of these categories as we are most familiar with. However, any individual dental insurance plan may very well may categorize or provide benefits for these dental services differently. You will simply have to check the terms of the specific insurance plans you are evaluating.
» Preventive (and Diagnostic) dental services.
This category typically includes the procedures and treatments listed below. In most cases, the level of dental insurance coverage provided for Preventive dental services is relatively high. With many plans it is on the order of 80% but with some insurance plans it can even be 100% of the UCR fee for these procedures. As an added point, you should check the individual dental plan that you are considering to see if the plan's deductible must be met before you receive benefits for Preventive services. In many cases you do not.
dental examinations, cleanings, x-rays, fluoride treatments, space maintainers, dental sealants
» Basic dental services.
Basic services are typically those types of dental treatments and procedures that are relatively straightforward in nature and don't involve a significant laboratory expense for the dentist. A dental insurance plan's coverage for these services will typically be on the order of 80% of the procedure's UCR fee. Typically these benefits are not paid until the member has met the plan's deductible. The types of procedures that the Basic category usually includes are listed below.
amalgam dental fillings, composite fillings (white fillings), routine tooth extractions, root canal treatment, periodontal treatment such as scaling and root planing and possibly periodontal surgery, recementing dental crowns, possibly dental crowns
» Major dental services.
The third category, Major dental services, typically includes those types of procedures and treatments that are relatively more complex in nature and often involve a dental laboratory expense. Usually these services tend to be more costly than those found in the Basic category. It is common that the level of benefits provided for procedures found in the Major category run on the order of 50% of the procedure's UCR fee, after the insurance plan's deductible has been met. Major dental services typically include the following procedures and treatments.
dental crowns, dental bridgework, removable partial dentures, complete dentures, orthodontic treatment
