What Are Preventive Basic And Major Dental Services?
What do dental policies usually cover, e.g., preventative care, filling cavities, orthodontics, cosmetic dentistry?
Most dental plans cover all these kinds of dental procedures except cosmetic surgery. Plans may vary mainly in the amount of coverage for each service, and how you pay for what is not covered. An employee may have a co-payment, co-insurance or a defined dollar amount to pay for a given service, depending on the type of program.
Different dental services provide most or all of these services, and can be categorized into three general areas:
- Preventive care
- Basic care
- Major care
Preventative care covers such items as exams, cleanings, and x-rays. Since these precautions are deemed necessary to prevent costly dental problems, they are usually covered by a dental plan or a nominal co-payment per visit at 100 percent.
List of Preventive / Diagnostic dental services
- cleanings (prophylaxis)
- bitewing x-rays
- periapical x-rays
- full-mouth, panorex x-rays
- 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)
Ideally, your plan will provide these services at least at these frequencies.
- Examinations - twice per year.
- Bite-wing x-rays - once per year.
- Teeth cleanings - twice per year.
- Full mouth x-ray series - once every three years.
Additional preventive dental care for children and adolescents.
- Topical fluoride treatments - twice per year.
Basic care includes dental problems, such as extractions or fillings. Their level of coverage may or may not include root canals. The insured will either have a co-payment or a co-insurance policy. In some cases, this may be a common dollar amount, as with a DHMO.
List of Basic dental services
- emergency care for pain relief
- amalgam fillings
- composite fillings (white fillings)
- sedative fillings
- routine tooth extractions
- root canal treatment - (maybe Major service)
- periodontal scaling and root planing
- periodontal surgery (maybe Major service)
- recementing dental crowns
- stainless steel (prefabricated) crowns
- non-routine x-rays
Primary treatment requires more complex procedures and as such facilities are to a lesser extent provided. Such facilities are often provided by a different lifetime maximum amount, which includes crowns, braces, dentures, and bridges. Many policies will not include cosmetic procedures as these are considered non-essential to the dental health of the employee. Beauty treatments include bleaching, veneers and bonding. In almost every dental plan, reimbursement for these facilities will be the employee's responsibility.
List of Major dental services
- dental crowns (may be a Basic service)
- inlays and onlays
- tooth implants
- impacted wisdom teeth removal (maybe Basic)
- complex oral surgery procedures
- removable partial dentures
- complete dentures
- denture relines and rebases
- denture repair
- orthodontic treatment
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