Dental Insurance
Dental Insurance Coverage Explained
Glaser Dental accepts all plans with out-of-network benefits
And to make it easy, we’ll submit the paperwork to your insurance.
What should I expect to pay?
Below is a link to help you estimate your dental care costs. It will show an estimate for out-of-network/uninsured and an average allowed amount by a health plan. The information is supplied by a third-party health care organization, FairHealth Consumer (not your insurance company and not us). It uses your Zip Code to determine the fair cash price.
Dental insurance FAQs
Below are answers to common, and some commonly misunderstood, questions about dental insurance coverage and reimbursement.
How do dental insurance plans calculate what they reimburse you?
UCR & MAC… Here is what they mean
UCR or Usual and Customary – Well… the letters in UCR stand for Usual, Customary, and Reasonable. Almost sounds like the Insurance company is doing extensive surveys of dental fees in your zip code and then taking the average, but guess what? That is not what the Insurance company does. Insurance companies calculate the UCR differently, but it’s usually between the 50th and 80th percentile of dentists’ fees in a geographical area.
The UCR fee guide generated by the insurance company is a price they will allow for every dental procedure they cover. This is not based on what a dentist charges but on what the dental insurance will cover for the premium your employer wants to provide.
MAC or Maximum Allowable Charge – If your policy uses a MAC fee schedule, your employer determines the maximum allowable fee per procedure. Some hire an actuary to assist in this determination to ensure the employer’s benefit budget is met. The MAC is generally determined by the cost of the premium for the plan selected by the patient. This is why it differs greatly from plan to plan within the same company.
To further complicate things, the Insurance company only covers a % of their UCR or MAC fee. From its inception, dental benefits were meant to allow for some patient out-of-pocket expenses. Amazingly, the UCR / MAC fees can vary between insurance companies and different employer-sponsored plans at the same company. This is because dental benefits and the associated UCR/MAC fee schedule are determined by the negotiations between the insurance company and your employer. Your employer has likely selected a fee schedule corresponding to the premium cost they desire.
All MAC/UCR fees used by plans are proprietary information and typically cannot be obtained by the provider or patient. You can try. We encourage you to call your dental plan (number on the back of your insurance card) or talk directly with your HR or benefits department at work and request your MAC / UCR fee for the dental procedures in question.
Insurance worksheet
Click to download a print-ready version of the worksheet below
Preventive Dental Services- Routine dental procedures like cleanings and x-rays are considered preventive or diagnostic services. As the name implies, preventive care services help maintain good oral health and identify possible problems early, saving you from pain and greater expenses later.
Common Preventive Dental Services & Their CDT code (billing codes)
Examinations CDT 0120 & 0150
Dental cleanings CDT 1110 & 4910
% of PREVENTIVE my plan will cover___________________________________________
Basic Dental Services-When you get into restorative work like fillings, you move beyond preventive care and basic dental services. Just remember, preventive work stops potential problems or corrects them early to get your oral health on the right track; basic services are restorative work to fix the damage that has already occurred.
A Common Basic Dental Services CDT code (billing code)
Composite Fillings (code depends on how many surfaces are diseased) codes for anterior teeth are CDT 2330, 2331, 2332
% of BASIC my plan will cover_________________________________________________
Major Dental Services-Complex dental work and surgical procedures, like implants, are classified as major dental services. These services are often lengthy or complex procedures to address issues that may have been caught and mitigated by earlier preventive care.
A Common Major Dental Service
Porcelain Crown – CDT 2740
% of MAJOR my plan will cover___________________________________________________
questions to ask my plan or HR department about these codes specific to my health:
CDT CODE____________________________________________________________
MAC or UCR reimbursement $ from my plan_____________________________
% coverage on the UCR / MAC___________________________________________
CDT CODE____________________________________________________________
MAC or UCR reimbursement $ from my plan_____________________________
% coverage on the UCR / MAC___________________________________________
CDT CODE
MAC or UCR reimbursement $ from my plan_____________________________
% coverage on the UCR / MAC_______________________________________________