On average, delta dental insurance will cover dental implants at 50% and the estimated average cost would be $1500 but coverage varies from plan to plan.
However, if you have a frequency limitation or a missing tooth clause, either of those may deny you benefits for your treatment. We will explain what all of that means but before we start, you need to understand the different implant components and the billing codes used for them.
Table of contents:
Dental codes for implants
The dental implant is actually three separate components and each of them have a separate dental code for billing purposes. Although luckily for you, delta dental usually covers all of them at the same percentage.
Three components of an implant and their codes:
Implant body (D6010) - this is the piece that is implanted into the jaw bone.
Implant abutment (D6057) - this piece connects the body to the crown
Implant crown (D6065) - this is the actual tooth cap that attaches to the abutment.
Delta dental coverage for implants
On average, the coverage for an implant with delta dental insurance is about 50% which means you'll have a 50% copayment. In other words, you'll be responsible for paying half of the treatment cost.
Below is an example of a benefits breakdown from one of our patients. It shows 50% coverage which is what we see on average with delta plans.
As you can see in the example above, all three components are covered at the same percentage.
However, that doesn't mean that you can't have more or less coverage for this treatment with delta. We have seen some of our patients with plans that do have higher coverage and also some with lower coverage as well. We've also seen unfortunate ones which don't have any coverage for it at all.
It all comes down to the specific plan that you purchased and signed up for.
Higher coverage example
To prove our point, below is an example of one of our patients who has higher than average coverage. They have 60% coverage to replace their missing tooth which is more than average.
Cost of implants with delta dental
The average cost of an implant with delta dental is $1500 and that is if you have 50% coverage for implant services. That amount includes the cost for all three of the implant components.
The table below will break down the copay for each of the three codes:
Implant ADA Code | Coverage | Estimated Copay |
|---|---|---|
D6010 (Body) | 50% | $700 |
D6057 (Abutment) | 50% | $400 |
D6065 (Crown) | 50% | $400 |
If you add up the copays for all three pieces you get $1500 and that will be your out of pocket expense.
Missing tooth clause
There is a stipulation in some insurance plans called the missing tooth clause. This clause can deny you implant benefits if you were missing that tooth prior to getting your insurance.
That means if you purchase the insurance in hopes of replacing your already missing tooth, you'll be out of luck.
If you have the missing tooth clause, you can still get benefits for an implant IF you get a tooth extracted while you're on the insurance. Any other situation will preclude you from insurance coverage.
Frequency limitations
Most dental insurances including delta dental have a frequency limitation on how many times you can get the implant done. Typically, the frequency limitation for a dental implant is once every 5 years.
Below is an example of a frequency limitation for this procedure. Delta highlighted the link in GREEN, "limitations apply." We've circled and underlined the part where it says so.
What this means is that you can only get this treatment once every 5 years. If something happens to it within that time frame, you'd need to pay for it out of pocket.
Potential complications requiring another implant:
Implant crown that fell out
Entire dental implant comes out
What else to keep in mind
Despite delta dental covering 50% of the implant costs, you do have to watch out for your annual maximum benefit. Most insurance plans have $1500-$2000 of dental benefits per calendar year and if you exceed it, you will not get any more help from your insurance.
If the estimated average cost of an implant is $1500 that actually puts you right about maxing out your annual benefits if you only have a $1500 max. In fact, you may have even exceeded it if you had a dental check up, cleaning, and annual x-rays done.
If you max out your insurance, you will be responsible for the remaining difference.
Takeaway
Yes, delta dental insurance can cover dental implants and they usually give 50% coverage. Although it can be higher if you have a better plan.
Key points:
The average coverage is 50% with a 50% copay.
The estimated average cost is $1500 with 50% coverage.
Call your insurance to check if there is a missing tooth clause.
There is a 5 year frequency limitation on implant services.
As long as you fulfill all of the conditions above, you will get your insurance benefit to replace your missing tooth. Restoring it will provide you with additional chewing power.
Disclaimer: All of the information given in this article only applies if you receive dental care from a dentist that is in network with delta dental. If you see an out of network provider, the information here would not apply. FYI, our dentists in long island city are in network with delta dental insurance.
