Key Dental Insurance Terms
Coverage percentages below are illustrative examples, not a statement of your benefits. Your policy, network, deductible, and remaining benefits determine payment.
Premiums
The amount paid to maintain your dental insurance, often monthly. Paying a premium does not mean every service is covered in full.
Copays
A fixed amount you pay for an eligible service. The plan pays its applicable share; deductibles, exclusions, and other charges may still affect your balance.
Preventive services
Care intended to help prevent oral health problems, such as exams, routine cleanings, and certain X-rays. Some plans cover eligible preventive care at 100% of the plan allowance, subject to network, frequency, and age rules. Scans and fluoride are not automatically covered.
Basic services
A plan category that may include fillings, simple extractions, and some periodontal treatment. Some plans pay 70–80% of the eligible allowance after the deductible, but classifications and percentages vary.
Major services
A plan category that may include crowns, bridges, dentures, and sometimes root canals. Some plans pay around 50% of the eligible allowance. Waiting periods, exclusions, replacement limits, and classifications vary by policy.
Deductible
The amount you may need to pay for eligible care before certain plan benefits apply. Some services may be exempt.
Annual maximum
The most your plan pays toward eligible services during its benefit year. Check your remaining amount and reset date.
Coinsurance and copay
Your share of eligible charges, expressed as a percentage or a fixed amount. Other uncovered charges may also apply.
Network participation
Whether your particular dentist and office participate in your specific plan network. A carrier name alone does not establish network status.
Waiting periods and limits
Rules that can affect when benefits begin, how often a service is covered, or which treatment alternatives the plan pays for.
Orthodontic lifetime maximum
A separate lifetime limit may apply to orthodontics, sometimes with age restrictions. It differs from an annual maximum.