Insurance, in any form, is often a confusing puzzle. From deductibles and maximums, to waiting periods and frequency limits, it might seem impossible to keep it all straight! We are always available to help our patients understand and make the most out of their dental insurance benefits, but here is an intro into the dental insurance world!
PPO Dental Insurance
The two most popular and known types of dental insurance plans are PPO and HMO plans. PPO stands for “Preferred Provider Organization”, a type of program in which participating dental providers contract with an insurance company and agree to a fee schedule of payment for dental services. These fees are commonly drastically reduced fees (compared to normal office fees). In return, PPO providers are placed on that insurance company’s list of preferred providers which is then distributed to plan members.
PPO plans typically determine coverage levels for dental services based on categories and percentages of coverage. Additionally, most PPO plans allow biannual (twice yearly) exams, cleanings and annual bitewing x-rays, covered at 100% by your insurance company. Here is a breakdown of typical PPO insurance coverage:
(NOTE: Coverage varies by the plan you or your employer have chosen. This is meant only as an example of PPO dental insurance coverage, NOT a model for all plans.)
| PPO Insurance Coverage (example) | ||
| Yearly Maximum | Varies; $500-$2,000 on average | |
| Yearly Deductible | Varies; $25-100 per individual on plan | Applies to basic and major procedures |
| Preventive | Biannual exam, cleaning, x-rays, Fluoride treatment, Sealants, Emergency exams and X-rays | 100% |
| Basic | Routine Fillings, extractions | 80% |
| Major | Root Canals, Surgical Extractions, Crowns, Bridges, Implants, Partial/Full Dentures | 50% |
