Dental Insurance Explained Like You Are Five

Cover Image for Dental Insurance Explained Like You Are Five
Arpit Goyal
Arpit Goyal
Posted underInsurance


There are three types of dental insurances — Medicaid/Medicare, HMO, and PPO. We will be discussing PPO insurance in this article. PPO Insurance allows you to see any dentist of your choosing. PPO Dental Insurance in Orland Park, IL typically costs $30-$50 monthly or $360-$600 yearly. Your insurance plan will typically have a “maximum benefit” of $1,500. This means that the insurance will pay up to $1,500 per year for your dental procedures. After your insurance pays out $1,500 on your behalf, all further expenses will have to be paid by you until your insurance renews. We will now explain how insurances determine how much to pay for each procedure.


A deductible is the amount that you have to pay before your insurance will start paying money on your behalf. A deductible is typically $50-$100. Once you pay this deductible, your insurance will pay up to the maximum benefit (typically $1,500) for your dental procedures.

Three Dental Categories

There are three dental categories to be aware of — Preventative, Restorative, and Major.

Most insurances will pay 100% for preventative procedures, 80% for restorative procedures, and 50% for major procedures.

The remaining % that insurance does not pay for has to be paid by you. Therefore, you will typically have to pay 20% of the restorative procedures cost yourself and 50% of the major procedure costs yourself.

Furthermore, there is also a fourth category called Cosmetic that dental insurances will cover 0% of. This is because cosmetic dental work isn’t required to keep one’s teeth healthy but rather something patients may elect to get to further enhance their teeth. These include procedures such as teeth whitening, dental bonding, and Invisalign braces.


Please note that this is just an example based on what we typically see but each individual plan is different.

Let’s say your dental insurance has a maximum benefit of $1,500 and a deductible of $50. You go in for a semi-annual check up which includes an exam, x-rays, and a simple cleaning. The diagnosis is that you will require a filling on one of your teeth for a cavity they found. Therefore, four procedures were done. Exam, x-rays, and a simple cleaning fall under the preventative procedures category. The cavity filling falls under restorative procedures category.

Let’s break it down in a table. We will show how much of each procedure insurance will cover and how much of each procedure you will have to pay for out of your own pocket.

ProcedureInsurance PaysTotal CostInsurance PortionPatient Portion

In this example, although insurance covers 100% of your Exam, insurance will only start paying after you pay your deductible. Therefore, after you pay your $50 deductible, insurance will start paying for your further treatments such as X-Rays and Cleanings. Insurance has paid out $320 on your behalf in this example. Therefore, out of the maximum benefit of $1,500, you still have $1,180 remaining for other procedures that you want to get done.

Which Dental Insurance to Choose

Choosing a dental insurance plan can be overwhelming. It is important to look at how much your monthly payments will be as well as the maximum benefit and what percentage of the three main categories are covered.

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Arpit Goyal
Arpit Goyal