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insurance industry has grouped dental procedure into three class
for the purpose of determining benefit and settling insurance claims.
The first of these is preventative. These are all
for procedures that are performed periodically to identify dental
needs and treat them before they become problem. Some examples are
oral exams, radiographies and prophylaxis (polishing of teeth).
These services are usually exempt from the deductible requirement
and covered from 100% to 85% of the dentist's fee.
The second group is basic or restorative. These are
all procedures that consider restoring oral health. Some examples
are filling, scaling and root plane, pulpotomy and extractions.
These services usually require the deductible to be met before benefits
are provided and are covered from 90% to 75% of the dentist's fee.
The last group is major. These are all the procedures
that involve significant oral reconstruction. Example are periodontal
surgery, crowns, bridge and dentures. These services usually require
the deductible to be meet before benefits are provided and are covered
from 70% to 50% of the dentist's fee.
Orthodontics are covered by some policies and usually
have a separate orthodontics deductible that must be meet before
benefits are provided. There is also a individual lifetime maximum
and coverage is usually at 50% of the dentist's fee.
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