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Dean George is the Marketing Specialist and Content Creator for Dental Insurance
Store and its social media channels. He is a regular contributor to Agent Straight Talk, the
only consumer blog explaining the ins, outs and in-betweens of dental insurance and
discount dental plans. READ MORE

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Unlocking the Mysteries of Dental Fees

Jun 08, 2016

By Dean George

Ever wonder why some dental procedures are considered basic and others major? If you answered “so the dentist can charge more,” you should know that cynical thinking has been found to cause cavities and may lead to premature tooth loss - accidentally on purpose.

Just kidding. In this post we'll unlock the door and explore the secrets on the difference between basic and major dental procedures.

First, major procedures are more expensive for the same reason that a gourmet meal costs more than a Happy Meal – because of the expertise, time and training involved.

All dental plans have specific codes for dental procedures based on importance. For example, x-rays and oral exams are diagnostic procedures designed to evaluate your chompers and confirm they are in good working condition.

Second, diagnosing a problem and probing to see what’s wrong is understandably less complicated – and less expensive – than correcting the actual problem. Asking a dentist to evaluate why your tooth hurts without an exam and x-rays is like asking a mechanic to diagnose why your car isn’t running right without looking under the hood. 

The same applies for preventive procedures. Having your teeth cleaned regularly or having sealants applied to your child’s teeth is comparable to having regular oil changes and tire rotations on the family vehicles. Preventive dental procedures and preventive car maintenance are both less expensive than a molar root canal or having a new rear wheel assembly installed.

Whether it is teeth or tires, being proactive and practicing preventive behavior helps guard against small problems becoming bigger problems. Bigger problems cost more to fix, and that’s why many plans offered by Dental Insurance Store cover the bulk of preventive care costs (some at 100%) twice a year.

Insurance plans don’t like paying for major dental procedures any more than you enjoy paying more for them out of your own pocket.

Preventive care is often referred to as “cleanings” but preventive treatments include several essential steps that encompass the health of your teeth and gums.

Preventive treatments may include:

  • Prophylaxis (teeth cleaning)
  • Polishing
  • Fluoride treatment
  • Tooth decay screening
  • Gum disease evaluation
  • Oral hygiene instruction
  • Evaluation of existing fillings and crowns
  • Basic Care

    Basic procedures are routine procedures that don’t require surgery like fillings, simple extractions and repairs to crowns, dentures or bridges.

    Dental Health Maintenance Organizations (DHMO) and discount dental plans usually cover basic procedures immediately upon the plan’s effective date. Preferred Provider Organizations (PPO) and indemnity plans require a six-month waiting period before they will pay for most basic procedures. PPO and indemnity plans also require meeting an annual deductible ($50 to $100) before the plan begins to pay for dental treatment.

    Major Care

    Major procedures include dental surgery, construction of a dental appliance and may involve sedation. DHMO’s and discount dental plans usually cover major procedures immediately upon the plan’s effective date. PPO’s and indemnity plans usually require a waiting period of 12-18 months before they will pay for major procedures. The annual deductible mentioned above applies to all dental procedures with costs, including the major ones.

    Major treatments may include but are not limited to:

  • Extraction of impacted wisdom teeth
  • Root canals
  • Crowns
  • Gum surgery (Periodontal)
  • Dentures and bridges
  • Temporomandibular treatment
  • Why do major procedures cost more? Performing root canals, treating diseased gum tissue and extracting wisdom teeth require professionals that specialize in those complex procedures. The endodontist that performs root canals, the periodontist that is treating patients for gingivitis and the oral surgeon that is removing wisdom teeth have undergone additional training and expense to master those specific dental disciplines.

    It’s true that most oral health specialists charge more than a general dentist, but think of it this way: who would you prefer to work on your $50,000 automobile, the person with little experience who works for a big box retailer, or a specially trained technician that has undergone specific training and certification to work on the make and model of your vehicle?  

    We all would like to keep our natural teeth our entire lives so don’t they deserve the same level of TLC as the family vehicle you hope lasts until it’s paid off?

    As previously mentioned in this space, tooth enamel is irreplaceable. When tires wear out on your car, you replace them with a new set. If your brake shoes and pads are worn, you replace them with new ones. If your oil light comes on, you add oil or change the oil and filter.

    Adding, replacing or growing more tooth enamel is impossible. Once it’s gone, it’s gone. Which is why if you’re not treating your teeth to regular dental visits, you should click here now and find a dental plan in your area that can help pay for those regular six-month visits.

    Thanks for reading Agent Straight-Talk, and for more helpful news on dental plan shopping tips and oral health news, follow us on social media at FacebookTwitterPinterestGoogle+, or LinkedIn.

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    Copyright 2016, Bloom Insurance Agency, LLC  

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