Most plans cover routine exams (2/year), cleanings (2/year), bitewing X-rays (1-2/year), and full-mouth X-rays (1/3-5 years) at 100% in-network.
Standard coverage is two cleanings per year (every 6 months). Some plans allow 3-4 cleanings for patients with periodontal disease.
Yes, preventive X-rays are typically covered at 100%. Bitewing X-rays 1-2 times yearly and full-mouth or panoramic X-rays every 3-5 years.
Preventive care usually has no waiting period or only 30 days. Insurers want you using preventive services to avoid costly problems.
Fluoride is typically covered only for children under 16-19. Adult fluoride treatment is considered elective and usually not covered.
Sealants are covered for children, typically on permanent molars up to age 14-16. Adult sealants are generally not covered.
Visual oral cancer screenings during regular exams are covered. Advanced screening technologies (VELscope, etc.) may not be covered or require additional cost.
Usually yes, preventive care counts toward your annual maximum. Some plans exclude preventive from the maximum to encourage regular care.
This common structure means: 100% coverage for preventive care, 80% for basic procedures (fillings, extractions), 50% for major work (crowns, root canals).
Deep cleanings (scaling and root planing) are classified as basic or periodontic procedures, typically covered at 80%, not as preventive services.