Cosmetic Dental Procedures Typically Covered by Insurance

The popularity of cosmetic dental procedures has recently increased, with more people seeking them to improve the appearance of their smiles. From dental veneers to teeth whitening, cosmetic procedures can significantly enhance your teeth's aesthetic and boost your confidence.

However, one prevalent question patients have is whether insurance covers these treatments. The answer to this question depends on the type of procedure. Some cosmetic procedures are covered, others are not. This blog discusses what cosmetic dental procedures insurance covers to assist you in making decisions regarding your oral care.

Insurance Coverage for Cosmetic Dental Procedures

Earlier, we mentioned that whether insurance covers a cosmetic dental procedure depends on the type of procedure and why you are doing it. Some cosmetic procedures are conducted for restorative purposes, while others are conducted for purely cosmetic reasons. Even though both of these categories of procedures aim to enhance the appearance of a patient's smile, they serve different purposes.

Purely cosmetic procedures focus only on improving the aesthetic appearance of a patient's smile and teeth. On the contrary, restorative procedures are conducted to correct functional problems with a patient's teeth, like missing, broken, or decayed teeth. In other words, restorative procedures are considered medically necessary.

Generally, dental insurance does not cover purely cosmetic procedures, as they are deemed elective and not medically necessary. Dental insurance typically prioritizes coverage for procedures essential for maintaining dental functionality and oral health. That said, dental insurance usually covers the following cosmetic procedures:

Dental Bridges

As the name suggests, dental bridges bridge the gap that missing teeth leave. A dental bridge comprises two or more crowns for the missing teeth. The supporting teeth are called abutment teeth, and a prosthetic tooth is placed in between. The prosthetic teeth are known as pontics and could be porcelain-, alloy-, or gold-made. Bridges are anchored in place by dental implants or natural teeth.

Dental bridges come in various types: traditional, cantilever, Maryland-bonded, implant-supported, and removable. They have several functional benefits besides enhancing the appearance of a smile; hence, insurance covers them. These benefits include the following:

  • They restore a patient's ability to speak and chew properly
  • Correctly distribute the force in a bite by replacing a missing or knocked-out tooth
  • Prevent the remaining natural teeth from shifting out of their position

The cost of bridges varies based on the type and patient’s location. Dental insurance generally pays a percentage of the cost based on the patient's plan. Without insurance, dental bridges cost between $1,500 and $5,000 per bridge. An implant-supported bridge may cost as much as $15,000.

Dental Crowns

A crown refers to a tooth-shaped cap. Apart from enhancing the appearance of a smile, crowns are used to restore the function and structure of decayed, broken, or weak teeth. The dentist fits the crown over an entire tooth. To ensure the crown fits properly, a dental professional must extract a small amount of tooth enamel before cementing it. Crowns are made from various materials, including porcelain, metal, and resin. Some of their functional purposes include the following:

  • Strengthening a weak tooth
  • Protecting and supporting a cracked tooth
  • Restoring broken or worn-out teeth
  • Holding a bridge in its place
  • Covering dental implants
  • Covering a root canal-treated tooth

The cost of dental crowns is based on the material used. Generally, it ranges between $500 and $3,500 per dental crown. Insurance will cover up to 50% of the cost; the patient must cover the remainder.

Dental Fillings

Dental fillings refer to materials utilized to repair damaged areas of teeth. If you have a dental cavity, your dental professional will likely extract the decayed section of the tooth with a drill, leaving a gap or hole that has to be filled to safeguard the tooth, and a dental filling is used for this. Dental fillings come in various materials, including porcelain, gold, composite resin, and amalgam.

Dental fillings may last for several years. However, their durability is based on oral hygiene, eating habits, and the kind of filling material; some materials are longer-lasting than others.

Dental fillings cost between $100 and $1,150 per tooth and, at times, more. This cost depends on factors such as the filling material. Insurance covers dental fillings because they are deemed medically necessary. However, it might not pay for all types of fillings. For example, insurers usually consider amalgam and composite resin fillings medically necessary but may not cover porcelain or gold fillings.

Dental plans might also have restrictions on paying for dental fillings. For example, some plans do not cover a replacement filling procedure on the same surface and tooth during the same year. Some dental plans do not also cover tooth-colored or white dental fillings for molars and premolars.

In other cases, there might be a waiting period, that is, the period during which a dental insurance plan has you wait from the enrollment period before covering fillings. A waiting time can range between six and 12 months. Before you undergo the dental filling procedure, you want to consult your insurer to determine what they cover, how much they will pay, and whether there is a waiting period.

Dental Implants

Dental implants refer to small threaded frames or posts that replace the missing roots of the teeth. Most implants are made of titanium, though others are ceramic-nade. Both ceramic and titanium are biocompatible (friendly to mouth tissues) and safe.

A dentist places an implant into the jaw underneath the gum by conducting a surgical procedure. After the implant heals, the dentist can affix a dental crown on top. The dental professional can restore the implants with dentures, bridges, or crowns based on your oral health needs.

Patients with a single or several missing teeth can be viable dental implant candidates. For example, you may need an implant if you have suffered tooth loss because of cavities, bruxism, tooth root fracture, facial injury, gum disease, or congenitally missing teeth.

Covering your treatment with dental implants might require utilizing dental and medical insurance, depending on why you need them. You want to check your policy to determine whether dental implant treatment is listed in the insurance information you were given when you began the policy. Before beginning treatment, you want to ask your insurer questions to be sure you will not encounter any unpleasant surprises.

Onlays and Inlays

Onlays and inlays are dental restorations used to treat a tooth cavity larger than a filling can treat but smaller for a crown to be used. Your dentist may recommend an inlay if your cavity lies in the tooth's center or within the grooves of your tooth. An onlay, on the other hand, may be recommended if you have more extensive decay or a cavity that spreads to the biting surface or tooth's edge.

Onlays and inlays generally fit better than dental fillings or crowns; thus, they are sometimes used as an alternative. They are also more durable and stronger than crowns and fillings. A dentist molds fillings into place during an office visit, while onlays and inlays are pre-molded in a laboratory before they are fitted and cemented to the teeth.

The costs of inlays and onlays are comparable. On average, inlays cost between $250 and $1,500, while onlays cost between $350 and $1,500 per tooth. The cost varies based on factors like the patient’s location, dentist experience, location of the affected tooth, size of the dental onlay or inlay, and type of material.

Most insurers cover part or all of the dental onlay and inlay costs. Dental insurers categorize onlays and inlays as either major or basic, affecting how much of the cost might be covered. Generally, the basic categorization covers routine services and onlay or inlay treatments, while a major category covers only a percentage of the cost.

Orthodontic Treatment

Orthodontic treatments are conducted to straighten teeth and correct a patient's bite. These treatments include traditional braces, clear aligners, clear braces, and retainers.

Even though orthodontic treatment is usually deemed purely cosmetic, insurance might cover it partly if it is necessary to rectify misalignment problems that could impact oral health, like difficulty chewing or bite problems.

Orthodontic treatments are usually very costly. To reduce treatment costs, check to see whether insurance will cover it and if you meet any waiting period requirements before treatment. Ensure you comprehend your dental plan so you do not have to pay for unanticipated costs.

Knowing what type of orthodontic treatment you need will help you find a dental insurance plan that covers it. Whereas most plans cover these treatments, ensure you know about any additional costs that might be part of your treatment. After your treatment starts, keep reviewing the terms of your dental plan to take advantage of any discounts you are eligible for.

Cosmetic Dental Insurance Not Covered by Insurance

The following procedures are not covered by dental insurance as they are considered to be conducted for purely cosmetic reasons and do not restore dental functionality:

Dental Veneers

Dental veneers come in various materials, including porcelain, composite resin, and Lumineers. A veneer is a thin, strong shell attached to a tooth's front surface. Like bonding, a veneer can hide several cosmetic mistakes, including discoloration, chips, and cracks. All veneers necessitate some extraction of tooth enamel. Consequently, the treatment might be reversible, depending on your selected type. In many cases, veneers need replacement every ten years.

Tooth Contouring or Shaping

The tooth contouring or shaping procedure extracts small quantities of enamel to alter the teeth’s shape. Since a patient only has so much natural tooth enamel, there is a limit to the amount a dentist can extract. Tooth contouring or shaping can be completed in one office visit.

Dental Bonding

The dental bonding procedure involves applying tooth-colored composite resin to the affected tooth. Your dental professional utilizes this material to hide and cover discoloration, craze lines, cracks, and other cosmetic imperfections. Bonding can alter a tooth's shape by elongating, widening, or making it more uniform.

Usually, the dental bonding procedure needs to be repeated every five to seven years to replace the composite resin material. The procedure does not require removing the original tooth enamel; thus, it is entirely reversible.

Teeth Whitening

With time, dark-colored drinks and foods, such as tea, berries, and coffee, can stain teeth. The teeth whitening procedure can significantly and safely brighten a patient's smile by lightening the shade of their teeth. Most dental professionals offer in-office and at-home teeth whitening procedures. An in-office procedure will take about an hour. At-home procedures often take several weeks.

Gum Contouring or Gum Reshaping

Some people have excess gum tissue. In this case, a smile can appear non-uniform or gummy. The gum reshaping procedure entails the dentist removing excessive gum tissues and reshaping the gum line for a more symmetrical and balanced appearance.

Factors Impacting Insurance Coverage for Cosmetic Dentistry

The extent to which insurance covers cosmetic dental procedures can vary based on various factors, including the following:

  • Out-of-pocket costs—if your policy does not pay for cosmetic dental procedures or only covers the treatment partially, you might have to pay for the treatment out of your pocket. Most dental clinics offer flexible payment options, like financing or payment plans, to make cosmetic procedures more affordable.
  • Alternative treatment procedures—in some instances, insurance might pay for alternative treatment procedures that serve the same purpose as cosmetic treatments. For example, if a dental filling can restore a tooth instead of using a dental veneer, insurance might cover the dental filling cost.
  • Pre-authorization requirements—insurers may require pre-approval or pre-authorization for particular procedures to establish whether or not they are restorative or medically necessary. You may be denied coverage if you fail to acquire pre-approval.
  • The type of dental insurance plan—some plans offer more comprehensive coverage for particular treatments than others. You want to review your dental insurance policy carefully to understand its coverage.
  • Tax considerations—in certain instances, cosmetic dental procedures might qualify for tax deductions if considered medically necessary to treat a dental condition. Consult a tax professional to establish whether or not you are eligible for any tax benefits associated with cosmetic dentistry costs.

Find a Knowledgeable Cosmetic Dentist Near Me

Whereas cosmetic dental procedures significantly enhance the appearance of our smiles, you want to know that insurance may not cover them in many cases. Before going through a cosmetic procedure, consult your insurer and dentist to understand your coverage options and possible out-of-pocket costs. By knowing and being proactive, you will likely choose the best procedure for your smile's aesthetics and dental health.

At the Dr Joseph Goodman Clinic, we provide our patients with expert advice about cosmetic dentistry and insurance coverage, in addition to offering high-quality treatment. Where insurance does not cover a particular cosmetic dental procedure, we offer various dental payment options that can make the procedure more affordable. If you seek cosmetic dentistry treatment in Beverly Hills, call us today at  310-860-9311 to discuss your options.

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Dr. Joseph M. Goodman, DDS Beverly Hills Center for Cosmetic Dentistry Advanced Cosmetic and Implant Dentistry. 2nd Floor at 241 1/2 S. Beverly Drive Beverly Hills, CA 90212