Insurance

There are several easy ways to confirm your dental insurance coverage. You can contact your insurance provider directly to get details about your plan, including deductibles, copayments, and covered services. You can also reach out to our team at East Town Dental. Just provide your insurance carrier’s name and subscriber ID, and we’ll obtain a detailed breakdown of your benefits so you have a clear understanding of your coverage.

Dental insurance works differently from medical insurance in a few important ways. Like other employer-provided plans such as medical or vision coverage, it includes monthly premiums and often favors in-network providers. However, dental insurance typically has an annual maximum benefit limit, while medical insurance generally covers costs after you reach your out-of-pocket maximum. Understanding these key differences helps you make the most of your dental benefits with East Town Dental.

Dental insurance works much like medical insurance but with some key differences. Most plans cover treatment costs up to a set annual maximum, after which the patient is responsible for any additional expenses. It’s important to know your plan’s annual limit, especially for higher-cost procedures. Dental PPO plans typically include coverage for preventive, basic, and major services, though the percentage covered varies by plan. Understanding your policy details helps you make informed decisions and prepare for any out-of-pocket costs not covered by insurance.

In-network means that our office has a contract with your insurance provider, allowing you to receive covered services at discounted, pre-negotiated rates. Out-of-network means we don’t have a direct contract with your provider, but we can still work with your insurance. In those cases, we use the standard service fee and apply your plan’s out-of-network coverage percentage to determine your portion of the cost. At East Town Dental, we accept most major PPO insurance plans.

Most dental insurance plans cover a variety of services, including routine checkups, professional cleanings (usually twice a year), fillings, crowns, oral surgery, and sometimes orthodontic care. Coverage is typically divided into three categories—preventive, basic, and major—with each having its own coverage percentage. Patients are responsible for any remaining balance after insurance payments. Orthodontic benefits often come with specific age limits, lifetime maximums, and other plan restrictions.

PPO dental insurance, or “Preferred Provider Organization,” offers flexibility in choosing your dentist without requiring you to select a primary provider. You also don’t need referrals to see a specialist. While you can visit any dentist, staying within the PPO network usually provides lower costs. In comparison, HMO or DHMO plans often have lower or no copayments but require you to choose a primary dentist and receive care only through that provider or by referral.

Most PPO dental insurance plans cover two routine exams and cleanings per calendar year to help maintain your oral health and prevent future dental issues.

Many dental insurance plans offer coverage for implants, but it can vary depending on your policy. Some plans include specific conditions, such as a “missing tooth clause,” which may limit coverage if the tooth was already missing before your policy began. Our team can review your plan and help you understand exactly what’s covered for your implant treatment.

In many cases, dental insurance does provide coverage for orthodontic treatments such as Invisalign. However, these benefits often come with certain conditions, including age limits, beneficiary restrictions, and a lifetime maximum rather than an annual allowance. Our team can help you review your plan and understand the exact details of your orthodontic coverage.