How dental billing actually works
Insurance pays by category of service. Your plan booklet controls percentages, exclusions, and annual limits, not a blog post.
Typical PPO coverage tiers (plan-specific)
- Preventive (exams, bitewings, cleanings): often 100%, with frequency limits.
- Basic (fillings, simple extractions): often about 80% after deductible.
- Major (crowns, bridges, dentures, sometimes implants): often about 50% after deductible.
Watch for deductibles, annual maximums (often about $1,000 to $2,000 for adults), waiting periods, and missing-tooth clauses.
Common ADA procedure codes on estimates
- D0150 comprehensive oral evaluation
- D0120 periodic oral evaluation
- D0210 / D0274 X-rays
- D1110 adult prophylaxis (cleaning)
- D4341 / D4342 scaling and root planing
- D2740 crown
- D6010 implant body placement
- D3330 molar root canal therapy
Questions to ask for a written estimate
- Which ADA codes are proposed, and are they on my plan fee schedule?
- What is my remaining deductible and annual maximum?
- Are you in-network for my plan?
- Will you submit a predetermination before major work?
- For phased treatment, what is due at each visit if insurance pays partially?