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What Is Covered by PPO Dental Insurance?
Each dental plan categorizes basic and major procedures slightly differently, so if you need dental work done, you will have to check with your specific plan. Although there are minimal differences in PPO dental plans in terms of what they cover and their costs, most PPO plans offer similar coverage for the following procedures.
Preventative Care Services (full coverage):
Annual or semi-annual visits for cleanings
X-rays
Sealants
Fluoride treatments
Basic Procedures with Discounted Co-Insurance Fee:
Treatment for Gum Disease
Fillings
Root canals
Extractions
Major Procedures with Discounted Co-Insurance Fee:
Crowns
Bridges
Inlays
Dentures
Root Canals (on some plans)
Most dental insurance, including PPO plans, will not cover any cosmetic procedures. This generally includes teeth whitening, shaping, veneers or any gum contouring. These treatments are only meant to improve the look of teeth and are not medically necessary. Anything that is not essential to the oral health of a patient must be covered by the patient in full.
A Preferred Provider Organization (PPO) is the most common type of dental insurance. It gives you a list of dentists to choose from who have agreed to charge lower prices. This helps you save money. PPO plans usually pay for part of your dental care—100% for cleanings and check-ups, about 80% for things like fillings, and around 50% for bigger treatments like crowns or bridges. Most plans also have a yearly limit of $1,000 to $2,000 and help with billing your insurance.