True or false: everyone that has dental insurance is entitled to two “free” dental cleanings every year.
False! There are actually quite a few things wrong with that statement.
Almost every dental insurance covers preventive services like cleanings and exams at 100%. That is why so many people consider them to be free. First of all, almost every dental plan has a yearly maximum allowance. Your ‘yearly max’ is usually between $1000 and $2000. Everything you get done at the dentist (except for orthodontics) comes out of that yearly allowance. Say you get a cleaning in January. In March you get your wisdom teeth taken out. You go to your 6-month appointment in July thinking everything is covered as usual. Unfortunately, that oral surgery in March used all of your yearly benefits!
Another way that patients get stuck with a bill after their cleaning appointment is they didn’t wait long enough from their previous appointment. Some insurance companies allow patients to get two cleanings whenever they choose throughout the year, which is great, especially for college students! Unfortunately, some are extremely strict about how often you can get a cleaning and will not pay a dime if you are even one day short of 6 months.
Did you know that if you have a cleaning and exam at one appointment, and an emergency exam at another appointment, your third exam at your next cleaning appointment won’t be covered? Even if you have plenty of benefits remaining, insurance companies almost never cover 3 exams in one year. Now you may be thinking, “that isn’t fair, they’re different exams.” You’re right – they are even coded differently (D0210 is a periodic exam and D0140 is a limited problem focused exam). Sadly, insurance companies consider all exams as the same, which means you’re out of luck if you want a third exam in a benefit year.
Have you been diagnosed with periodontal disease? Your dentist has probably recommended follow-up periodontal maintenance appointments instead of regular cleanings. The standard of care is actually periodontal maintenance appointments every 3-4 months instead of every 6 months. On top of that, insurance companies no longer treat your periodic visits as preventive, therefore, they think they should pay less than 100%. Not only is your dentist recommending you come in more often, your dental insurer is only willing to cover 2 visits per benefit year, and only wants to pay 80% of the cost!
There are probably a few more ways that your two “free” cleanings end up costing you money, but these are the top reasons I see dental insurance companies weasel out of paying for your preventive treatment. I hope this article helps you avoid some unnecessary bills in the future.
Michael has been a dental office manager in New Jersey for close to 10 years. Kittatinny grad (1999). BA in TV from Emerson College in Boston, MA. Retired Marine Corps. BS in Nursing from NYU in 2010. OR Nurse at Hospital for Special Surgery. Enjoys the outdoors and spending time with his wife and kids.