Understanding Your Dental Benefits - A Glossary of Terms
Reading your dental benefits package can often feel like trying to learn a new language. We hope this glossary of common terms will help you decode your insurance coverage and as always, if we can help in any way, please contact our office.
In general, basic services are typically those types of treatments and procedures that are relatively straightforward in nature and don't involve a significant laboratory expense for the dentist. Basic services are often lumped in with preventative services that when done on a regular basis can prevent further dental intervention. Most plans cover these services from 80-100% and are subject to an annual maximum.
Such services usually include:
scaling and prophylaxis (cleaning up under the gums and polish)
routine x-rays: bitewings, periapical, full-mouth, panorex
fluoride treatments (age limitations may apply)
space maintainers (may be a Basic service, age limitations may apply)
tooth sealants (may be a Basic service, age limitations may apply)
emergency care for pain relief
fillings on cavities
routine tooth extractions
periodontal scaling and root planing
root canal treatments*
periodontal surgery *
* are not covered as Basic Services under some plans
The Major dental services category typically includes procedures and treatments that are relatively more complex in nature and often involve a dental laboratory expense. These services tend to be more costly than those found in the Basic category. Not all insurance plans cover major expenses which is why before we proceed with any Major service, we send a dental estimate to ensure coverage. If your plan does have Major coverage, it is ususally covered between 50-100% and can either have a separate maximum, or be included in a total annual maximum for all services.
Major services usually include:
dentures and partial dentures
specialty x-rays (such as 3D CBCT)
Orthodontic services refer to anything involving moving teeth. This can range from braces to retainers, orthodontic appliances and associated x-rays, exams and other diagnostic services such as impressions. Orthodontic services are usually covered at no more than 50%, and have a separate annual/lifetime maximum.
Scaling/Root Planing: Cleaning up under the gumline. Most plans include a set number of "units" usually allotted per year - in our office, 1 unit refers to 15 minutes of time.
Recall Examination: What most people refer to a "check-up." Most plans allow for an adult to receive a check-up exam once every 6-9 months, and most children every 6 months.
Specific/Emergency Examination: When something happens to your teeth and you need to be seen between check-ups, it's either a specific or emergency examination. We do not charge a premium for emergency examinations, and depending on the circumstances of your case, either/or may be used for billing.
A note on Cleanings/Exams:
Most plans include enough scaling(cleaning) units to be seen at least twice per year (some up to 4 times per year!) but only allow for an examination by the dentist only once every 6-9 months. If this is the case for you, you may choose to come in more frequently for cleanings, but only see the dentist once per year. If you ever have a dental concern, let us know, and we will check it out whether you're covered or not.
Is there a dental term you want clarified? Let us know in the comments below!