Going to the dentist is an important part of maintaining good oral health and preventing more serious and costly dental problems down the road. But for those without dental insurance, the costs associated with even routine dental appointments can be prohibitively expensive.
For the insured, dental coverage can help substantially offset costs, making routine preventive, diagnostic, and minor restorative visits more affordable. But how much do you still have to pay out-of-pocket with insurance? Here’s a breakdown of typical dental appointment costs with insurance.
Insured Dental Visit Costs
How much is a dentist appointment with insurance varies widely based on the type of dental plan you have, but there are general ranges for the patient responsibility portion. With dental insurance through an employer group plan or by purchasing private dental insurance, costs for preventive services like cleanings, exams, and x-rays are often fully covered or have only a small copayment.
Basic restorative services like fillings may have higher copays or require meeting an annual coverage deductible first. Major services are the most expensive for patients, typically requiring coinsurance payments of 10-50%.
Preventive Dental Appointment Costs
The fully or mostly covered services that encompass preventive dental checkups and cleaning appointments make routine dental exams and cleanings highly affordable with insurance. Typical out-of-pocket costs include:
Dental Exam – $0 to $35 copay
Routine dental exams consisting of a visual inspection of your teeth and existing dental work as well as a check for oral cancer are typically fully covered by dental insurance. Expect to pay little or nothing out-of-pocket per exam thanks to preset copay amounts set by your policy.
Dental Cleaning – $0 to $75 copay
Professional dental cleanings to remove plaque and tartar from teeth to prevent decay and gum disease are another staple service intended to be low or no cost to the patient thanks to dental benefits packages. Like exams, set copay fees apply per visit.
Dental X-rays – $0 to $100 copay
Necessary bitewing, periapical, panoramic and other dental x-rays used to evaluate tooth and jaw health also fall under routine preventive services. Per image copays may apply but are often waived.
Minor Restorative Dental Costs
Moving up from purely diagnostic and preventive services, minor restorative treatments like basic fillings to treat tooth decay also have cost-sharing arrangements through insurance that limit patient costs. What you can expect to pay includes:
Tooth-Colored Filling – $50 to $200 copay
Composite resin fillings placed to fill cavities after decay removal range from mostly covered to about 50% coinsurance rates. More extensive fillings come with higher copays.
Metallic Filling – $30 to 150 copay
The silver amalgam fillings are the more budget friendly option. Expect to pay less in copayments compared to the more cosmetic composite fillings.
Tooth Extraction – $75 to $400 copay
Removing unrestorable infected or problematic teeth is a common procedure. Copays average about $100-200 per tooth but vary case by case based on difficulty level.
Major Dental Service Costs
More complex dental treatments classified as major services under insurance have the highest out-of-pocket costs for policyholders but are still discounted through partial coinsurance provisions. Typical percentage shares of costs for patients can include:
Dental Crown – 50% coinsurance
Dental crowns to restore heavily filled or fractured teeth cost approximately $800 to $1700 on average. With coinsurance, insured patients pay roughly $400 to $850 per crown.
Root Canal Treatment – 50% coinsurance
Root canals run $700 on average per tooth. You would be responsible for about $350 per root canal after insurance contribution.
Dental Implants – 10% to 50% coinsurance
Dental implant surgery is among the most expensive services, with average costs ranging from $1500 to $6500 for the full procedure. Out-of-pocket expenses under coinsurance can amount to a few hundred to over $3000.
Understanding Dental Insurance Plans
The dental insurance plan type – whether obtained through an employer, privately purchased, or through a government health program – determines the coverage levels and out-of-pocket costs policyholders pay. Key elements influencing visit costs include:
Annual Maximum Benefits
Most dental benefits packages limit how much the plan pays out in total per policy period, usually $1000 to $2500 per covered family member. Once this cap is exceeded, patients pay 100% of further costs.
Deductibles
Some but not all dental plans have an annual deductible ranging $25 to $200 that the individual must pay out-of-pocket towards covered services before coverage begins. This does not apply to basic cleanings and exams in most cases however.
Allowed Dental Fees
Insurers establish their own allowable fee schedule that caps the dollar amounts they will reimburse dentists. If your dentist’s fees exceed plan allowances, you pay the difference out of pocket. Seeing an in-network dentist prevents balance billing.
Factors Influencing Dental Visit Affordability
Even with insurance coverage taking up part of the costs, paying your share of dental treatment expenses can still be challenging. Elements that impact affordability for insured patients cover:
Extent of Recommended Dental Work
More involved courses of dental treatment inevitably mean higher out-of-pocket costs for patients with insurance. Serious cases of tooth decay requiring many fillings, root canals plus crowns for example quickly add up in copays and coinsurance.
Choice of Dental Materials
Opting for more advanced tooth-colored composite fillings and porcelain crowns rather than basic silver amalgam and gold crowns tacks on added expenses not covered by insurance. You pay the difference in materials upcharges.
Choice of Dentist
Seeing an out-of-network dentists means you may be balance billed above what insurance covers for any given service. Even in-network, specialist dentists are allowed to set their own rates leading to higher copays.
Strategies to Reduce Dental Costs with Insurance
While insurance goes a long way in making dental care reasonably affordable even on a limited income, you can take added steps to reduce your out-of-pocket dental costs further. Some money-saving tactics include:
Get Preventive Dental Care
Sticking to regular exams and cleanings avoids developing expensive-to-treat issues like cavities and gum disease that lead to higher expenses down the road.
Alternative Dental Plans
Consider joining a dental savings plan for deeper discounts on services from set-fee dentists if your current insurance falls short. Shop plans during open enrollments as well.
Dental Tourism
Certain major procedures like crowns and implants that have high copays and coinsurance costs in the U.S. can be obtained far more affordably abroad in countries like Mexico. Long wait times for some elective services through overloaded NHS dental services in the UK also lead many British citizens to travel abroad using dental tourism options.
Government Dental Benefits
For struggling individuals and families unable to afford job-based or private purchase dental insurance policies, government-funded dental benefits programs provide basic coverage at little or no cost. Options like Medicaid dental benefits, Veterans Affairs (VA) dental insurance programs, and the Indian Health Service (IHS) dental plan serve vulnerable population groups with incomes below the Federal Poverty Level. Restrictions, limitations, or waiting periods for coverage may apply however.
Those over age 65 who lack access to retiree dental benefits may also qualify for supplemental dental coverage under various Medigap or Medicare Advantage plan options.
In Conclusion
How much is a dentist appointment with insurance varies greatly based on your specific policy provisions but can reduce costs for services substantially when comprehensive coverage is in place. Those without dental benefits still have options as well, from dental savings plans and discount networks to government assistance programs.
Staying proactive with preventive dental appointments remains key however to avoiding extensive restorative work and ensuring oral health for the long run. Discussing payment and insurance questions with your dentist openly is also advised, so you know what to expect cost-wise upfront before moving forward with recommended treatments.
