Examples of routine care include:

• Restorative care – amalgam and composite resin fillings and stainless steel crowns on primary teeth

• Endodontics – treatment of root canals and removal of tooth nerves

• Oral Surgery – tooth removal (not including bony impaction) and minor surgical procedures such as tissue biopsy and drainage of minor oral infections.

• Periodontics – treatment of uncomplicated periodontal disease including scaling, root planning and management of acute infections or lesions

• Prosthodontics–repair and/or relining or reseating of existing dentures and bridges.

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Does the plan give you the freedom to choose your own dentist or are you restricted to a panel of dentists selected by the insurance company? If you have a family dentist with whom you are satisfied, consider the effects changing dentists will have on the quality or quantity of care you receive. Because regular visits to the dentist reduce the likelihood of developing serious dental disease, it’s best to have and maintain an established relationship with a dentist you trust

Who controls treatment decisions–you and your dentist or the dental plan? Many plans require dentists to follow treatment plans that rely on a Least Expensive Alternative Treatment (LEAT) approach. If there are multiple treatment options for a specific condition, the plan will pay for the less expensive treatment option.

If you choose a treatment option that may better suit your individual needs and your long-term oral health, you will be responsible for paying the difference in costs. It’s important to know who makes the treatment decisions under your plan. These cost control measures may have an impact on the quality of care you’ll receive.

Does the plan cover diagnostic, preventive and emergency services? If so, to what extent? Most dental plans provide coverage for selected diagnostic services, preventive care and emergency treatment that are basic for maintaining good oral health.

But the extent or frequency of the services covered by some plans may be limited. Depending upon your individual oral health needs, you may be required to pay the dentist directly for a portion of this basic care. Find out how much treatment is allowed in any given year without cost to you, and how much you will have to pay for yourself.

• Initial Oral Examination—-once per dentist

• Recall Examinations—-twice per year

• Complete x-ray survey—-once every three years

• Cavity-detecting bite-wing x-rays—-once per year

• Prophylaxis or teeth cleaning—-twice per year

• Topical Fluoride treatment—-twice per year

• Sealants—-for those under age 18

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