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Dental Insurance Benefits

Zak Dental answers the most common questions about: dental insurance benefits provided to our patients; insurance facts our patients should know.


If you live in Southern California, feel free to Schedule a New Patient Visit with us in Zak Dental offices in Agoura HillsCovina/San DimasDowneyLong BeachNorth ParkSan DiegoSanta BarbaraSimi ValleyTemeculaValenciaVentura, and Whittier/La MiradaCalifornia.

For all your dental needs, schedule an appointment by calling the Zak Dental office at 833-ZAK-TEAM.


Dental Insurance Benefits FAQ

What is dental insurance?

Dental insurance is a type of health insurance designed to pay a portion of the costs associated with dental care. It typically covers preventive services, such as cleanings and exams, as well as more extensive procedures like fillings, extractions, and sometimes orthodontic work.

What types of dental insurance plans are available?

There are several types of dental insurance plans, including:

  • Preferred Provider Organization (PPO): Offers a network of dentists to choose from. You can see out-of-network providers, but at a higher cost.
  • Health Maintenance Organization (HMO): Requires you to choose a primary dentist within the network. Services outside the network are generally not covered.
  • Dental Discount Plans: Not insurance, but provide discounts on dental services from participating dentists.
  • Indemnity Plans: Offer more flexibility in choosing dentists and pay a percentage of the provider’s fee.

What services are typically covered by dental insurance?

Coverage varies by plan, but generally includes:

  • Preventive Care: Exams, cleanings, X-rays, fluoride treatments (usually covered at 100%).
  • Basic Services: Fillings, extractions, periodontal treatment (typically covered at 70%-80%).
  • Major Services: Crowns, bridges, dentures, oral surgery (typically covered at 50%).
  • Orthodontic Services: Braces and other orthodontic treatments (coverage varies widely and may have a separate lifetime maximum).

What is a deductible in dental insurance?

A deductible is the amount you must pay out-of-pocket before your dental insurance begins to pay for covered services. For example, if your deductible is $50, you pay the first $50 of covered services yourself.

What is a copayment or coinsurance?

Copayment (Copay): A fixed amount you pay for a specific service at the time of the visit.
Coinsurance: A percentage of the cost of a service that you are responsible for paying after meeting your deductible.

What is an annual maximum?

The annual maximum is the maximum amount your dental insurance will pay for covered services in a benefit year. Once you reach this limit, you are responsible for any additional costs. Common annual maximums range from $1,000 to $2,000.

What is a waiting period in dental insurance?

A waiting period is the amount of time you must wait after your policy starts before you can receive coverage for certain services. Preventive services often have no waiting period, but basic and major services may have waiting periods ranging from 3 months to a year.

How do I know if my dentist is in-network?

You can find out if your dentist is in-network by:

  • Checking your insurance provider’s website or app for a list of in-network dentists.
  • Calling your insurance company directly.
  • Asking your dentist’s office if they accept your insurance plan.

How do I file a dental insurance claim?

For in-network providers, the dentist’s office typically files the claim on your behalf. For out-of-network providers, you may need to:

  • Obtain a claim form from your insurance provider.
  • Complete the patient section of the form.
  • Attach an itemized receipt from your dentist.
  • Submit the form and receipt to your insurance company by mail or online.

Can I use my dental insurance for cosmetic procedures?

Most dental insurance plans do not cover cosmetic procedures, such as teeth whitening, veneers, or cosmetic bonding, as they are not considered medically necessary. Coverage is typically focused on preventive and restorative treatments.

How often should I use my dental insurance benefits?

It’s advisable to use your dental insurance benefits regularly to maintain oral health and prevent more serious issues. Regular check-ups and cleanings are usually covered fully or at a high percentage, and can help you avoid costly treatments in the future.

What should I do if my claim is denied?

If your dental insurance claim is denied:

  • Review the explanation of benefits (EOB) to understand why the claim was denied.
  • Contact your insurance company for clarification.
  • Check if there was an error in the claim submission.
  • Ask your dentist’s office to resubmit the claim if necessary.
  • If you disagree with the denial, you can file an appeal following your insurance company’s appeal process.

If you have further questions or specific concerns about your dental insurance, contact your insurance provider or speak with your dentist’s office for detailed information and assistance.