Free Tool
Insurance Coverage Lookup
Check typical insurance coverage for common procedures across dental, medical, veterinary, and specialty practices — all in one place.
Step 1
Select your specialty
Choose the type of practice to see relevant procedures and coverage information.
Step 2
Browse coverage details
Filter by insurance plan or search for a specific procedure.
| Procedure | Code | Coverage | Typical Range | Avg. Cost | Notes |
|---|---|---|---|---|---|
| Routine Cleaning (Prophylaxis) | D1110 | Typically Covered | 80-100% | $100-$200 | Usually covered 2x/year. Most PPO plans cover at 100% in-network. |
| Comprehensive Exam | D0150 | Typically Covered | 80-100% | $75-$200 | Covered as preventive. New patient exam usually 1x per provider. |
| Dental X-Rays (Full Mouth) | D0210 | Typically Covered | 80-100% | $100-$250 | Full mouth series typically covered once every 3-5 years. |
| Filling (Composite) | D2391 | Typically Covered | 60-80% | $150-$400 | Basic restorative — most plans cover 60-80% after deductible. |
| Root Canal (Anterior) | D3310 | Typically Covered | 50-80% | $500-$1,000 | Major procedure. Waiting periods may apply on new plans. |
| Crown (Porcelain) | D2740 | Typically Covered | 50-60% | $800-$1,700 | Major restorative — often subject to 12-month waiting period. |
| Tooth Extraction (Simple) | D7140 | Typically Covered | 60-80% | $150-$350 | Oral surgery category. Usually covered 60-80%. |
| Dental Implant | D6010 | Often Not Covered | 0-50% | $1,500-$6,000 | Many plans exclude implants. Check for a specific implant rider. |
| Teeth Whitening | D9972 | Often Not Covered | 0% | $300-$800 | Cosmetic — not covered by insurance. Self-pay only. |
| Orthodontics (Braces) | D8080 | Often Not Covered | 0-50% | $3,000-$7,000 | Requires ortho benefit rider. Often has separate lifetime max (~$1,500). |
Routine Cleaning (Prophylaxis)
Usually covered 2x/year. Most PPO plans cover at 100% in-network.
Comprehensive Exam
Covered as preventive. New patient exam usually 1x per provider.
Dental X-Rays (Full Mouth)
Full mouth series typically covered once every 3-5 years.
Filling (Composite)
Basic restorative — most plans cover 60-80% after deductible.
Root Canal (Anterior)
Major procedure. Waiting periods may apply on new plans.
Crown (Porcelain)
Major restorative — often subject to 12-month waiting period.
Tooth Extraction (Simple)
Oral surgery category. Usually covered 60-80%.
Dental Implant
Many plans exclude implants. Check for a specific implant rider.
Teeth Whitening
Cosmetic — not covered by insurance. Self-pay only.
Orthodontics (Braces)
Requires ortho benefit rider. Often has separate lifetime max (~$1,500).
Disclaimer: Coverage information is based on typical plan structures and may vary by specific policy, network status, deductible, and plan year. Always verify coverage directly with your insurance provider before scheduling procedures. This tool is for informational purposes only.
Frequently Asked Questions
No. This tool provides general coverage information based on typical plan structures. Actual coverage depends on your specific policy, deductible, network status, and plan year. Always verify with your insurance provider before scheduling procedures.
Coverage varies based on your specific plan type (PPO, HMO, EPO), whether the provider is in-network, your deductible status, and the plan year. Preventive services are typically covered at 100% under ACA, while major procedures may have higher cost-sharing.
A deductible is the amount you pay out-of-pocket before insurance starts covering costs. For example, with a $1,000 deductible, you pay the first $1,000 of covered services yourself. Preventive care is usually exempt from deductibles under ACA-compliant plans.
Prior authorization (also called pre-approval) means your insurance must approve the procedure before it's performed. Without it, the claim may be denied even if the procedure is normally covered. Your healthcare provider's office typically handles this process.
Options include: asking about payment plans, looking into healthcare credit (CareCredit, Prosper Healthcare Lending), checking if your provider offers a cash-pay discount (many do 10-30% off), or appealing the insurance decision if you believe it should be covered.
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