Dental Insurance: What's Covered, What's Not

Dental Insurance: What's Covered, What's Not

Apr 24, 2023

Dental insurance reduces dental care’s overall cost, helping people maintain good oral health. It allows people to spend less from out-of-pocket when symptoms of an oral disease manifest or a needed procedure arise. KK Dental – Somerset covers portions of preventative dental care, orthodontic treatment, and restorative procedures.

Our Somerset dentist offers a “100-80-50” plan. The plan entails 100 percent regular preventative care, 80 percent basic procedures, and 50 percent effective procedures such as implants and bridges.

Dental Coverage: Preventative Care

This insurance plan covers 100 percent of preventative care, particularly after meeting the deductible. It includes the following:

  • Dental exams include regular oral exams where the dentist examines the mouth for signs of gum disease, cavities, and other associated conditions.
  • Routine teeth cleanings – the plan covers at most two professional teeth cleanings yearly. During the exercise, the dentist cleans the hard-to-reach plaque between teeth.
  • Dental x-rays – the plan also covers one x-ray annually. The x-ray may help diagnose oral diseases that are not visible during routine dental examinations.
  • Fluoride treatments – fluoride occurs and strengthens the enamel and prevents tooth decay. There are slight traces of fluoride in tap water, mouthwashes, toothpaste, and dental materials.
  • Tooth sealants – once your teeth develop visible pits and fissures, tooth sealants are applied to the teeth to prevent the early formation of a cavity. They can be done in adults, although they are best for children.

Dental Coverage: Basic Services

The insurance plan, like most others, covers 80 percent of essential services. The procedures include the following:

  • Cavity fillings – once you have a decaying tooth, dental fillings fill the minor dental cavity before it expands to cause serious dental problems.
  • Emergency x-rays – once you get involved in an accident, it may be necessary to have an emergency x-ray to help diagnose mouth injuries or damaged teeth. The plan usually covers X-rays.
  • Tooth extractions – depending on oral hygiene, you may need to remove some teeth. Teeth removal is primarily due to injury, disease, or severe decay. Non-surgical reduction is covered thoroughly, while surgical removal is partially covered.

Dental Coverage: Major Services

Most people have dental insurance because they want to be safe if they require stringent restorative procedures. Even though the insurance plan only covers 50 percent of the costs for major services, it is usually of great help. The techniques covered include the following:

  • Root canal treatment –Root canal therapy is an extensive dental procedure. It involves restoring the dental pulp of severely infected roots of teeth. It also relieves dental pain.
  • Dental crowns – in case you have a cracked, broken, or chipped tooth, it’s necessary to put a protective cover to prevent further damage and give your teeth a great visual appeal. Crowns go on top of such teeth. They are also placed on top of weak teeth, usually weakened by tooth decay.
  • Dental bridges – a dental bridge is a prosthesis that replaces single or several missing teeth in a dental arch. The existing teeth usually support it.
  • Scaling and root planning – plaque and calculus buildup on your teeth is often removed below and above the gum line.
  • Dental inlays and Onlays – these are indirect restorations. They are manufactured in an offsite laboratory. Onlays patch large cavities for a filling, while inlays are for small holes instead of fillings.
  • Dentures are an artificial substitute for a whole dental arch of a patient’s teeth. A denture resembles natural teeth, is usually removable, and helps preserve the surrounding tissues.
  • Dental restoration repairs – once your teeth have been fitted with dental devices, the insurance plan usually covers repairs on the replacement after they last for 12 months.
  • Oral surgery – most oral surgeries are covered by the insurance plan. They include tooth extractions and implant fixing.
  • Dental anesthesia – anesthesia is the medication used to minimize pain and discomfort during a dental procedure. The dentist may use local anesthesia for minor procedures while they use sedation for extensive dental procedures.


The key to dental health is ensuring you don’t get into problems. It would be best to focus on preventative dentistry since the plan fully covers it. If you pay attention to the plan’s first phase, you may never require coverage of the other stages for restorative and basic procedures.

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