dental insurance

I Have Dental Insurance, So Why Isn’t My Cleaning “Free”?

Dental insurance benefits can be quite confusing. At Raleigh Dental Arts, our top dentist in Raleigh, NC is here to help you better understand what you’re paying for.

One of the most common misconceptions with dental insurance is that you are covered for two “free” cleanings per year.  Well, this isn’t necessarily true. Let’s explain a little bit about this situation and why you’re led to believe that it will in fact, not cost you anything.

Your dental insurance company has a certain amount that it will pay towards your dental expenses every year.  Usually, the amount is around $1,000 to $2,000. Types of treatments are put into categories and each category is paid at a different percentage.

For example, the “preventive” category, which includes “regular (prophylaxis) cleanings”, x-rays, and exams, are commonly paid at 100%.  Meaning, you won’t have an out of pocket expense. Rather the fee that the dentist charges will be paid for by the insurance policy. However, this amounts it not in addition to the yearly maximum allowance.  Instead, it’s taken from it. So, as you can see – though you wouldn’t have to pay anything at the time of service, you’re paying for it throughout the year – in your monthly premium payment – and by having it affect your annual benefits.

More Than “Just a Cleaning”

Qualifying for prophylaxis (or prophy, for short), means that your mouth is healthy and there is no heavy tartar buildup under the gums that needs to be removed. When you end up having to pay for a cleaning is when your treatment isn’t considered a regular preventative cleaning.

If it’s been a while since you’ve had a professional cleaning, or if you’ve previously been treated for gum disease, then chances are you’ll need a deep cleaning.  This puts you in the category of “Periodontics” rather than “preventive”. Your treatment may be called “root planing and scaling”, or “periodontal maintenance”. These procedures are more complex, take more time to complete, and are thus billed differently. The provider will need to clean debris from underneath the gum tissue.  In some cases, you’ll even need to be numbed. As far as insurance goes, you’ll see that the policy will only pay between 50% and 80% of this procedure – leaving you to take care of the rest. Again, whatever the insurance does pay will be taken away from your yearly allowance. A deductible may also apply.

How Your Deductible Is Handled

Every year the first time you have dental work done, you’ll be required by your insurance carrier to pay a deductible. Usually, this amount is between $50 and $100 and doesn’t apply to the Preventive category of care.  But if the first time in that year you’re having root planing and scaling (a deep cleaning) done, then you’ll be required to pay your deductible, plus the percentage that your insurance policy doesn’t cover for that treatment (even if it is a type of cleaning.)

We’re Here to Help You Make Sense of Things

The professionals at Raleigh Dental Arts are here to help answer your insurance questions as best as possible. Our office even provides you with easy dental financing options in Raleigh, NC.  Give us a call today!

Tarun Agarwal

Dr. Tarun Agarwal, DDS is considered one of the top dentists in the country. He is a recognized speaker, author, and dental leader. He has been featured on CBS, NBC, ABC, FOX, and News 14 Carolina. Dr. Agarwal has been awarded '40 under 40' Business Leaders by the Triangle Business Journal. He is regularly invited to teach other dentists around the world and recently built a training center within the practice dedicated to sharing his expertise. Most importantly he is a loving husband and dedicated father of three wonderful children. His biggest accolade was being voted 'Best Dad in the World' by 2 of his 3 kids.