Preventative vs. Basic vs. Major Dental Services

Dental insurance can feel confusing, especially when plans talk about preventative, basic, and major services. Knowing what these categories mean and how they’re typically covered can help you plan your care, avoid surprise bills, and get the most out of your benefits.

Preventative Dental Services

Preventative services are all about keeping your mouth healthy and catching problems early, before they turn into something more serious (and more expensive).

Common preventative services include:

• Routine exams and checkups

• Cleanings (prophylaxis)

• X-rays (bitewings, full-mouth series)

• Fluoride treatments (often for children)

• Sealants (typically for kids and teens)

How insurance usually covers them:

Many dental insurance plans cover preventative care at 80-100%, meaning you typically pay nothing or very little out of pocket. In many cases, these services are also not subject to a deductible.

Insurance companies know that regular cleanings and exams reduce the risk of costly dental problems later. Preventative care is a win for both patients and insurers.

Basic Dental Services

Basic services address common dental issues that require treatment but are not considered complex or surgical.

Common basic services include:

• Fillings

• Simple tooth extractions

• Periodontal (gum disease) treatment, such as scaling and root planing

• Repair of existing crowns or fillings

How insurance usually covers them:
Basic services are often covered at 50–80%, meaning you’re responsible for the remaining 20–50% (called coinsurance). These services typically do require a deductible to be met first.

Some plans also impose a waiting period (often 3–6 months) before basic services are covered, especially for new members.

Major Dental Services

Major services involve more complex procedures, often to restore function or replace missing teeth.

Common major services include:

• Crowns

• Bridges

• Dentures

• Root canals (sometimes classified as basic, depending on the plan)

• Oral surgery

• Dental implants (coverage varies widely)

How insurance usually covers them:
Major services are usually covered at 20-50%, leaving you responsible for the other 50-80% of the cost. These services often:

• Require you to meet your deductible

• Have longer waiting periods (6–12 months is common)

• Count toward your plan’s annual maximum

• May be excluded if the tooth is already missing

Because major procedures can be costly, it’s especially important to confirm coverage details and pre-treatment estimates before starting care.

Important Things to Keep in Mind

• Annual maximums: Most dental plans cap the amount they’ll pay per year (typically $750-$2500). Once you hit that limit, you pay the rest.

• Waiting periods: New plans may delay coverage for basic and major services.

• Plan differences: Coverage percentages and service classifications vary by insurer and plan.

• In-network vs. out-of-network: Staying in-network usually lowers your out-of-pocket costs.

Why Understanding These Categories Matters

Knowing whether a procedure is considered preventative, basic, or major helps you:

• Estimate costs before treatment

• Time procedures strategically across benefit years

• Avoid unexpected expenses

• Maximize your dental insurance benefits

If you’re ever unsure, your dental office can help verify benefits and explain how a specific service will be covered under your plan.