Key terms
| Term | What it means |
|---|---|
| Annual maximum | The most the plan pays in a benefit year; you pay everything above it |
| Deductible | What you pay before the plan starts paying (often waived for preventive care) |
| Coinsurance | Your percentage share of the cost |
| Waiting period | Time before certain services are covered after you join |
| Missing tooth clause | Exclusion for replacing teeth lost before coverage began |
| Frequency limits | How often services such as cleanings or X-rays are covered |
The common coverage pattern
Many dental PPO plans follow a pattern often described as 100-80-50: preventive care covered at or near 100%, basic services (such as fillings) at around 80%, and major services (such as crowns and bridges) at around 50%. Your plan may differ, so read the summary of benefits.
Getting the most from your plan
- Use preventive visits every year.
- Ask for a pre-treatment estimate before major work.
- If you need extensive treatment, ask about splitting it across two benefit years.
- Check your dentist is in-network for your exact plan; see our insurance guide.
- Compare with dental savings plans if you need major work soon.
General information, not medical, legal or insurance advice. This post reflects the position on the date shown. Check the official sources below for the latest rules.
Last updated: 15 October 2026
