Most dental insurance follows a predictable 100/80/50 pattern: preventive care is usually covered at around 100%, basic work like fillings at around 80%, and major work like crowns, dentures, and implants at around 50% — all limited by your deductible and your annual maximum. Knowing where a procedure falls in that structure is the fastest way to predict what you will actually pay.
The 100/80/50 rule
Nearly every dental plan sorts procedures into three tiers. Preventive — routine exams, cleanings, and X-rays — is typically covered in full because it keeps bigger problems from forming. Basic — fillings, simple extractions, and often root canals — is commonly covered at around 80%. Major — crowns, bridges, dentures, and often implants — is commonly covered at around 50%. The exact percentages are set by your specific plan, but the shape is remarkably consistent across carriers.
What about braces and Invisalign?
Orthodontics sits outside the 100/80/50 structure. Plans that include an orthodontic benefit usually pay a percentage of braces or clear aligners up to a separate lifetime orthodontic maximum, and many limit that benefit to dependents under 19. If your plan has no orthodontic rider, braces and Invisalign are generally an out-of-pocket expense — though financing and our complimentary consultation can help you plan.
Implants, crowns, and oral surgery
Major and surgical work is where guests are most often surprised, because a single treatment is billed as several separate procedures that the plan may cover at different rates. Wisdom tooth removal is usually handled as oral surgery (commonly 50% to 80%); crowns are major (commonly ~50%); and implants are increasingly covered as a major service, though often only the crown portion. For the full breakdown on implants specifically, see our guide on whether dental insurance covers dental implants.
The two limits that decide your bill
Two numbers matter more than the coverage percentages. The deductible is what you pay before the plan starts contributing. The annual maximum — commonly $1,000 to $2,000 — is the most the plan will pay in a plan year, and for any larger treatment it is usually the binding constraint, not the percentage. Most plans run on a calendar year, and unused maximum does not carry over, so anything left on December 31 is lost. If you are weighing timing, we wrote up the math in how to use your dental benefits before they expire.
Waiting periods, missing tooth clauses, and networks
Two fine-print items catch people off guard: a waiting period (often 6 to 12 months before major services are eligible) and a missing tooth clause (which can exclude replacing a tooth lost before the policy began). Both are written into the plan document, so they are worth confirming early. Finally, staying in-network matters — in-network dentists have agreed rates, so your share is usually lower. Ideal Dental is in-network with many major plans; our insurance page lists the carriers we work with, and we file your claims for you.
FSA and HSA dollars count too
If you have a flexible spending account or health savings account, most dental treatment is an eligible expense. The difference matters at year end: FSA funds are typically forfeited if unused by December 31, while HSA funds never expire. Keep your itemized receipts, and confirm eligibility with your plan administrator.
The bottom line
Find where your procedure sits in the 100/80/50 structure, check how much of your annual maximum is left, and ask your dentist's office to submit a predetermination of benefits for anything major — your plan responds in writing with what it will pay before treatment begins. Book a visit at an Ideal Dental near you and we will verify your benefits and map your estimated share before anything starts.
Frequently asked questions
What does dental insurance usually cover?
Most dental plans follow a 100/80/50 structure: preventive care like exams, cleanings, and X-rays is typically covered at around 100%, basic work like fillings at around 80%, and major work like crowns and dentures at around 50% — all subject to your deductible and annual maximum.
Does dental insurance cover braces or Invisalign?
Orthodontics is usually a separate benefit. Plans that include it often pay a percentage of braces or Invisalign up to a lifetime orthodontic maximum, and many limit coverage to dependents under 19. If your plan has no orthodontic benefit, clear aligners and braces are out of pocket.
Does dental insurance cover dental implants?
Many plans now cover part of an implant as a major service, often the crown rather than the post, commonly at 20% to 50% and subject to your annual maximum. Coverage varies widely between plans, so it is worth requesting a predetermination of benefits.
Does dental insurance cover wisdom teeth removal?
Usually yes. Wisdom tooth extraction is generally covered as oral surgery, commonly around 50% to 80% depending on whether it is a simple or surgical extraction and subject to your plan's limits.
Does dental insurance cover crowns and root canals?
Root canals are typically covered as a basic or major service and crowns as a major service, commonly around 50% to 80% after your deductible and subject to your annual maximum. A crown is often needed after a root canal, so check how your plan treats each stage.
Why does my dental coverage reset on December 31?
Most plans run on a calendar year with an annual maximum that does not roll over. Any unused benefit is gone at year end, which is why late in the year is a common time to complete planned treatment.