Paying for Dental Care

Coding and how it affects payments

FAQ: “I thought my cleaning was free! why isn’t it free?”

ANSWER: UNLIKE MEDICAL INSURANCE THAT HAS DIAGNOSIS CODES AND TREATMENT CODES, DENTAL PROCEDURE CODES ARE COMBINED (DIAGNOSIS & TREATMENT IS ONE CODE). BEFORE YOUR TEETH ARE CLEANED, ASSESSMENTS ARE TAKEN TO DETERMINE THE HEALTH OF YOUR MOUTH. ONCE THE HEALTH AND DIAGNOSIS IS ESTABLISHED, THE CORRECT CLEANING CODE IS USED. THE CLEANING IS ESSENTIALLY THE SAME BETWEEN THE CODES, IT’S YOUR DIAGNOSIS THAT DICTATES THE CORRECT CODE.

PROBE DEPTH
Space between tooth and gum

<3 mm

<4 mm

>4 mm

BLEEDING
Sign of infection, % of gums that bleed

<30%

>30%

>30%

BONE LOSS
Diagnosed with radiograph

NO

NO

YES

PUS
Sign of infection

NO

NO

YES/NO

MOBILITY
Sign of advanced infection

NO

NO

YES/NO

CODE

D1110

D4346

D4910
after D4341 or D4342

IF YOUR EMPLOYER PROVIDES DENTAL INSURANCE, THEY HAVE CONTRACTED WITH AN INSURER TO PROVIDE CERTAIN BENEFITS.

HERE IS A COMPARISON OF SOME OF THE BEST, WORST, AND USUAL BENEFITS WE SEE.

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BEST: 4 cleaning/year

USUAL: 2 cleanings/year

WORST:2 cleanings/year

Code D1110

No out of pocket $

No out of pocket $

yes Copay/Deductible

Code D4346

No out of pocket $

Deductible applies

yes Copay/Deductible

Code D4910

No out of pocket $

Deductible/Copay apply

yes Copay/Deductible

SO, THE HEALTH OF YOUR MOUTH DICTATES THE CODE, YOUR INSURANCE DICTATES YOUR COST FOR THE CODE. DEPENDING ON YOUR INSURANCE PLAN, YOU MAY ALWAYS GET A “FREE CLEANING” WHILE OTHER PLANS ALWAYS HAVE YOU PAY A PORTION. CHECK WITH YOUR INSURANCE CARRIER OR HR FOR MORE SPECIFICS. ASK YOUR DENTAL HYGIENIST FOR SUGGESTIONS TO IMPROVE THE HEALTH OF YOUR MOUTH!

If you cannot afford the treatment recommended…

Some dental offices offer a private dental insurance plan. Call around for information.

If you have medical conditions that may be worsened by periodontal disease (diabetes, autoimmune diseases, etc), you may be able to have your medical insurance cover the cost. You will need to call around to find a dental office that knows how to submit claims to medical insurance.

If you have a Dental Hygiene Program, or Dental School in the area, you may receive treatment at a very discounted rate. Call the school for details. You often need to have a fair amount of time available.

You can call your local Health department for information on facilities that may offer discounted dental services.

Prevention, prevention, prevention! Take advantage of preventive options available.