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How Deductibles Work For Dental Insurance

The deductible for dental insurance must be paid before benefits start to cover your treatment but it only applies to certain procedure codes. In other words it is an out of pocket expense that must be paid by you before your benefits kick in.


Deductible for cigna insurance example
Deductible for cigna insurance example

When does the deductible apply

The deductible for dental insurance will usually apply for most basic and major procedures. Essentially, it is when you "get work done" that the deductible kicks in.


Examples of basic dental procedures:

  • Fillings

  • Deep cleanings

  • Extractions (erupted teeth)

  • Root canals


Examples of major dental procedures:

  • Crowns

  • Implants

  • Dentures

  • Orthodontics


The examples above serve as a general guideline but your particular insurance plan may differ. It all depends on the type of benefits that your HR department has negotiated for you.


The best way to be sure is to either ask your dentist or inquire with your insurance directly.


 

When the deductible does not apply

For most dental insurances, the deductible does not apply for a lot of the preventative and diagnostic procedures.


Examples of preventative procedures:

  • Adult prophy (adult teeth cleaning)

  • Child prophy (child teeth cleaning)

  • Fluoride


Examples of diagnostic procedures:

  • Oral examinations

  • X-rays (bitewings, PAs, PANOs)


The above is true for most of the PPO dental insurances that we take at our office.


Exceptions: From time to time, we do see some insurances where the deductible applies for the dental cleaning and also for the x-rays. Although more commonly, it would apply for the radiographs rather than the prophy.


 

How to calculate the deductible

The calculation for the annual dental deductible is a straight forward subtraction.


Example 1:

  • Treatment needed = Dental filling ($150)

  • Annual deductible = $50

  • Your copay = $50


Example 2:

  • Treatment needed = 1 x-ray ($25)

  • Annual deductible = $50

  • Your copay = $25


Example 1 should be straight forward.


For example 2, you only need to pay $25 despite it being $50 because the procedure itself only costs $25. If you were to get a second x-ray, you would need to pay the full $50. Although if you get a 3rd x-ray, that 3rd one would be fully covered and would not cost you an extra dime.


 

How often deductibles need to be paid

The deductible for dental insurance needs to be paid every year if you receive treatment where it applies. That is why it is also called the "annual deductible."


However, it is possible to not pay it if your insurance does not apply it to preventative and diagnostic and you only need a checkup and cleaning every year. If this is your situation, you can get away with not needing to meet the limit.


 

Takeaway

When you go see the dentist, you may be responsible for paying the deductible if you're getting treatment where it applies. Our dentists in Long Island City recommending verifying with your dental insurance ahead of time so that there are no surprises. Our front office can also assist you with that while you're making the appointment.

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About the author: Dr David Chen, DDS

Hello, I'm Dr Chen and I'm an actively practicing dentist in Long Island City, NY. I graduated from Columbia University College of Dental Medicine in 2016 but prior to going to dental school I was already working in the dental field. It's been more than a decade since I first got to know dentistry and let me tell you, time flies by quickly. Since then I've developed a fondness for writing, which is how this all got started!

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Medical Disclaimer:

This blog is purely meant for information purposes and should not be used as medical advice. Each situation in your mouth is unique and complex. It is not possible to give advice nor diagnose any oral conditions based on text nor virtual consultations. The best thing to do is to go in person to see your dentist for an examination and consultation so that you can receive the best care possible.

The purpose of all of this oral health information is to encourage you to see your dentist and to inform you of what you may expect during your visit. Due to the unfortunate nature of dentistry, there isn't really any true home remedies that will get rid of dental problems. Roughly 99.99% of them require in-person intervention by a healthcare professional.

Hint: That is the reason why you can't eliminate seeing dentists in your life!

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