Understanding the Cost and Coverage of PPO Dental Insurance Plans

Whether you have dental insurance through work or bought it individually, you should understand how costs and coverage differ. You’ll also want to consider deductibles and annual limits.

A PPO or preferred provider organization plan offers patients flexibility in choosing a dentist by providing a more extensive network of providers. But it often comes with a higher premium and a deductible.

Preventive Care

With PPO dental insurance plans, you will usually have access to a more extensive network of dentists and pay less when visiting one of them. You can also choose a fee-for-service plan or traditional insurance, which doesn’t require you to stay within a specific network.

DHMOs and DPPOs often have a list of services they cover at 100%, including teeth cleanings, oral exams, certain types of X-rays, sealants, and fluoride treatments. Other standard services covered by these plans include fillings, root canals, and extractions. They may have deductibles and coinsurance percentages but these are usually higher than with a PPO.

Routine Cleanings

Dental insurance is an excellent option for those who need more resources to cover their dental care costs out of pocket. However, it’s essential to understand how dental insurance works before committing to it.

Many dental insurance plans require that enrollees pay a deductible before the insurance company starts paying for treatment. Additionally, most dental insurance companies have annual maximums that limit how much they’ll pay for a year of coverage.

If you use a fee-for-service office, they will collect your payment at the time of service and file the claim with your insurance company. This is an increasingly common practice among patients with good dental insurance who want the flexibility of visiting non-contracted providers.


Most PPO dental insurance plans and some HMO or DHMO policies cover all routine preventive care, including bi-annual cleanings, exams, and dental X-rays. Most PPO and DHMO plans also don’t require paying any annual deductible.

Instead, they may charge a percentage of a contracted fee negotiated with the insurance company. PPO dental insurance is one of the most popular options for people seeking affordable coverage. Whether you are looking for individual or group dental coverage, premiums can vary widely, and it is essential to understand what your plan offers before you purchase it. This will help you make the best decision possible.


A Preferred Provider Organization (DPPO) plan offers an extensive network with discounted rates. If you visit an in-network dentist for a filling, your cost may be only $50 or $60, even before meeting your deductible.

Depending on the type of plan, copayments and deductibles vary. Some plans also have maximum benefit limits.

Consider the reputation of dental insurance providers when selecting a plan. You want a provider known for its customer service, affordability, and efficient claims processing. Many consumers also combine a dental insurance plan with a discount program. In this case, the plan covers preventative services, while the discount program offers discounts for significant care.


Generally speaking, most dental plans offered through the Marketplace cover basic procedures (like fillings) at 80% of the cost after you meet your deductible. However, these plans are all different. Some have higher monthly premiums and copayments, while others have lower fees and deductibles.

A top-tier dental PPO plan with a broad provider network may work for you if you want the freedom to see any licensed dentist and are okay with paying a little more each month than an indemnity plan. Just make sure to check the annual maximum and that crowns are covered. Some plans only cover 50% of the costs for these procedures.

Root Canals

If you opt for a DPPO plan, you’ll have access to an extensive network of dentists who have agreed to offer discounted services. These savings can offset the cost of your monthly premium and your deductible.

Dental insurance prices depend on many factors, including coverage levels, annual plan maximums, deductibles, and copayments. It’s also important to note that some plans, like traditional indemnity dental plans, need provider networks.

Look for a provider that offers flexible plan options and high customer service. This will ensure you get the most value from your policy and maximize your coverage. A good provider can also help you navigate the complex world of dental costs and coverage.


Different types of dental insurance are available, including Preferred Provider Organization (PPO) plans, which allow you to visit any dentist. These plans have a fee schedule that sets an agreed-upon price for specific procedures, which helps keep costs lower than they would be without the agreement.

PPOs also typically have more extensive networks of providers and do not require you to designate a primary care dentist. However, these plans can have higher out-of-pocket costs and annual maximums than DHMOs. Alternatively, you can opt for a traditional or indemnity dental plan to choose any dentist. These plans don’t usually have a provider network but can come with annual coverage maximums.


Most PPO plans come with a network of providers, which can give you lower rates on care. Many also feature an annual maximum that caps the amount you pay for a year; some have lifetime maximums. You’ll need to review your plan carefully to understand the coverage details.

Most DHMOs and DPPOs typically cover a flat fee for preventive services like fillings and tooth extractions (How to remove vans insoles?). However, primary restorative services like dental bridges, crowns, dentures, and oral surgery are often based on a patient’s deductible or MAC fees. Out-of-network costs are generally based on MAC fees as well. So, it’s essential to choose an in-network dentist.

Leave a Comment