With dental insurance, your annual cleanings are always going to cost you less than a filling or root canal, but do you know why? Your insurance classifies dental procedures into three main categories -- preventive, basic, and major dental services -- based on how complex and expensive they are.
Where a service falls within these levels will determine how much of it is covered. That’s great! But it still leaves us with some questions. Preventive vs basic vs major dental services, what are they, and is it even worth trying to figure that out?
It is! Learning about the procedure you're receiving and how it is classified can save you some pre-appointment stress and help you better navigate your insurance later. You won’t be caught off guard by an unexpectedly high fee, and you’ll have a better idea of what you’re having done entails. It's always a good idea to educate yourself about your plan. Luckily, for the most part, dental services break down pretty neatly into these categories. Let's have a look.
Preventive Care vs Basic vs Major Dental Services
Your dental insurance splits procedures into three major categories: preventive, basic, and major dental services. Your insurer will cover each category a certain amount, up to 100%. Just how much is covered will depend on your plan, but before we dive into that, let's break down each category.
Preventive Dental Services
Routine dental procedures like cleanings and x-rays are considered preventive, or diagnostic, services. As the name implies, preventive care services help you to maintain good oral health and can identify possible problems early, saving you from pain and greater expenses later.
Common Preventive Dental Services
Examinations and cleaning
(Bitewing and panoramic) x-rays
Basic Dental Services
When you get into restorative work like fillings, you move beyond preventive care and into basic dental services. Just remember, preventive work stops potential problems or corrects them early to get your oral health on the right track; basic services are restorative work to fix damage that has already occurred. Compared to major services, basic dental services are typically fairly straightforward, non-surgical procedures.
Common Basic Dental Services
Diagnostic (non-routine) x-rays
Simple (non-impacted) extractions
Emergency care for tooth/gum pain
Root canals (usually basic, but sometimes they can be classified as major)
Major Dental Services
Complex dental work and surgical procedures, like implants, are classified as major dental services. These services are often lengthy or complex procedures to address issues that may have been caught and mitigated by earlier preventive care. Generally speaking, if a procedure needs anesthesia or surgery or is an orthodontic procedure, it will likely be classified as a major dental service.
Common Major Dental Services
Extraction of impacted teeth
Anesthesia or sedation
Complex oral surgery
Orthodontic procedures (braces, retainers, etc.)
Coverage for Preventive vs Basic vs Major Dental Services
Alright! Now that we have an idea of where common procedures fall, it’s time to talk about how and if your dental insurance will cover them. Each individual plan is going to be different, and you should always familiarize yourself with your plan’s details before a trip to the dentist. That said, there’s some standardization.
Basic Coverage Dental Plans
If you have a basic dental insurance plan, you likely have coverage for most preventive care like checkups, cleanings, x-rays, and a few basic services like fillings. Basic plans won’t typically cover everything under the preventive or basic service blankets, however. Fluoride treatments are not always covered by basic plans, for example.
Full Coverage Dental Plans
It’s called full coverage, but that doesn’t mean 100% of the cost is covered for everything. Rather, full coverage dental plans offer more complete coverage than basic and, generally, lower out-of-pocket costs at time of visit. In addition to most preventive care, a good full-coverage plan will include partial coverage of costs for most basic and a lot of major restorative care, including orthodontic treatments.
Things To Keep In Mind
When shopping for dental insurance, there are a few things you should keep in mind.
Root canals and wisdom teeth could be classified as basic or major, depending on your plan and the nature of the work being done. Be sure to check your plan if you’re going to get one of these procedures done! Root canals are most commonly considered a basic dental procedure rather than major, and for wisdom teeth, whether or not the tooth is impacted will determine the procedure level.
Every plan is different. And what is fully covered by one may not be covered at all by another.
Remember copays and deductibles! Coverage is not always 100%. Regardless of the category of the care you’re receiving, you may be responsible for out-of-pocket costs like copays (fees paid at time of visit) or deductibles (a certain cost amount you must reach before coverage kicks in).
Dental insurance requires that you see an in-network dentist. If you’re going to an out-of-network dentist or orthodontist, the level of service may not matter at all--you may be responsible for the full cost of the procedure.
Maintaining your oral health is of vital importance, and learning about how dental services are classified will help you to make the best possible choices for how to cover that care. If you just need upkeep and minor restorative work, then preventive and basic services are where your focus should be. If you need extensive work or orthodontic services, then you should pursue a plan that offers coverage for major services as well!