Dental Benefit Categories and Coverages - Delta Dental
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Dental Benefit Categories and Coverages

August 19, 2014

Many dental plans offer 3 classes or categories of coverage. Each class provides specific types of treatment and typically covers those treatments at a certain percentage.

Each class also specifies limitations and exclusions. Reimbursement levels vary from plan to plan, so be sure to read your benefits information carefully.

Here are the typical levels in benefit plans:

Class I (usually called Diagnostic & Preventive)

  • Procedures are diagnostic and preventive and typically are covered at the highest percentage (for example 90 - 100% of the allowable dental charge).
  • Give patients a financial incentive to seek preventive care, because such care can prevent more extensive dental disease or even dental disease itself.

Class II (usually called Basic)

  • Includes basic procedures — such as fillings, extractions and periodontal treatment — that are sometimes reimbursed at a slightly lower percentage (for example 70 – 80%).

Class III (usually called Major)

  • For major services, such as crowns and dentures. This is usually reimbursed at a lower percentage (for example, 50%).
  • Class III may have a waiting period before services are covered.

Limitations and Exclusions

Dental plans are designed to help with part of your dental expenses. The typical plan includes limitations and exclusions, meaning the plan doesn’t cover every aspect of dental care. This can relate to the type or number of procedures, the number of visits or age limits.

No matter what type of a dental benefit plan you have, it’s important to understand your plan offerings so that you can use your benefits to help improve your health.

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