Dental coverage: preventive, basic, and major services
What each dental coverage tier includes, the typical coinsurance, and which services tend to get reclassified between plans.
Dental plans sort procedures into three categories that determine what share of the bill the plan pays. The category — not the procedure name — is what controls your cost.
Preventive (usually 100% covered, no deductible)
- Routine exams (typically 2 per year)
- Cleanings (prophylaxis, typically 2 per year)
- Bitewing and panoramic x-rays (at set intervals)
- Fluoride treatments (often limited to children)
- Sealants (often limited to children's molars)
Basic (usually 70–80% covered, deductible applies)
- Fillings (amalgam or composite)
- Simple tooth extractions
- Root planing and scaling (deep cleaning)
- Periodontal maintenance
- Emergency exams for pain or trauma
Major (usually 50% covered, deductible and waiting period apply)
- Crowns, inlays, and onlays
- Bridges
- Dentures (partial and full)
- Root canal treatment (endodontics)
- Surgical extractions (including impacted wisdom teeth)
- Implants (covered on some plans only)
Often excluded or limited
- Cosmetic procedures (whitening, veneers)
- Adult orthodontics (sometimes a separate rider)
- Implants (varies widely by plan)
- Replacement of restorations less than 5–7 years old
FAQ
- Are wisdom tooth removals basic or major?
A simple extraction is basic. A surgical extraction (the tooth is impacted, requires anesthesia, or removal of bone) is major. The dentist's procedure code tells the plan which category applies.
- Why was my crown classified as major when an old plan called it basic?
Categorization varies by plan. The plan documents — not the dentist — control how a procedure is classified.
- Are implants ever covered?
Increasingly yes, but often only the abutment and crown, not the implant post itself, and only as a major service at 50%. Read your plan's exclusions carefully.