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Will dental insurance cover fillings?

Yes, no and maybe  

Usually insurance plans cover fillings at the benefit level they allow for basic services. There may be a deductible and copay with the amount determined by the insurance contract. Also, some plans may only cover diagnostic and preventive services. In addition, there is often an additional copay with tooth colored composite restoration in the posterior areas due to plan limitations. Annual maximums, frequency limitations and other restrictions may also affect coverage.

As with many dental services when you have a dental plan, it is often best to predetermine treatment for an estimate of your out-of-pocket costs.

Dental insurance policies are legal contracts with many variables. Strictly speaking the questions as to benefits and coverage must be answered by the insurance carrier. The dentist can give informed opinions and attempt to interpret your contract as a service for you, but only the insurance company can give you the correct answer to this question.

That being said, it is very common for dental insurance policies to pay for a portion of the cost of routine fillings. The other specifics of how much, how often, what kind and so forth are virtually impossible for us to answer here. Consult with your HR department at your work.

Dental insurance can help people pay for dental treatment, but it has its limitations. Most insurance plans have a deductible of $50 to $100, pay only a specified percentage for each type of treatment, and have a yearly maximum amount of funds available for dental care.

Most preferred provider or PPO plans cover preventive care, cleanings, check-ups, protective dental sealants, x-rays, and fluoride treatment at 80-100%. Basic care, including root canal therapy, extractions, and fillings are usually covered at 80%. Major care such as crowns (caps), permanent bridgework, and full and partial dentures as well as periodontal (gum) care are often covered at 50%.

Many insurance companies have a yearly maximum of a $1000-$2000. Dental insurance is not cumulative, so if you don’t use it, you lose it.

 

Dr. Michael Roizen, MD
Internal Medicine

Maybe -- if you are about to get a cavity filled, you will soon learn that the guy who is making your teeth feel good, wants to get paid for his time and the products he uses. That’s when you will want to learn real fast about the dental insurance coverage you have. So, the short answer is, it depends. The longer answer is the treatments and procedures a given dental insurance plan has (more accurately called a dental benefits plan) can vary a lot. So while your best friend’s major root canal may have been completely covered by her plan, you may find that your plan doesn’t even cover the cost of a regular check-up and teeth-cleaning, or the parking fee at your dentist’s office.


So call up the number on your benefits plan card; call your benefits office at work, heck, call ‘em both. You want to figure out exactly what your plan covers so you avoid the double whammy of pain: a dental procedure and the huge bill that comes after those fillings have been placed.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.