Basic versus major versus preventive versus diagnostic…if you spend any time at all in a dental office, you may have heard these terms…but what does it all mean and why is it so darn confusing? Do you think some procedures are considered “Major” just so the dentist can charge more? If so, we forgive you for your cynicism. Here, we will sift through the layers of confusion and explain the differences between diagnostic, basic, and major dental procedures.
All dental procedures have specific codes. Like x-rays and exams. These are diagnostic procedures designed to evaluate your teeth and determine if they are in good working condition. Now…probing around to see what’s wrong is obviously less complicated (and less expensive) than correcting the issue. Asking a dentist to tell you why your tooth hurts without an exam and x-rays is like asking the mechanic to tell you why your car isn’t running without looking under the hood. Likewise, having your teeth cleaned regularly is similar to having regular oil changes on the car. Preventive dental procedures and preventive car maintenance are both less expensive than a root canal or having a new transmission installed. Other examples of preventive and diagnostic care include teeth cleaning (prophy), polishing, fluoride treatment, and gum disease and tooth decay screening. So…whether it’s teeth or the check engine light, practicing preventive behavior helps guard against small problems becoming big problems. Big problems cost more to fix and that’s why many insurance plans cover most preventive care twice a year…and typical of insurance plans, they don’t want to pay for the major procedures if they don’t have to.
Basic procedures are routine and do not require surgery…for example fillings, simple extractions, and repairs to crowns and dentures. Some dental plans cover basic procedures immediately upon the plan’s effective date. Preferred Provider Organizations (PPO) and indemnity plans most often require a 6-month waiting period and also require meeting an annual deductible before they will pay for most basic procedures. It’s always a good idea to read the fine print in your insurance plan so you’re not hit with surprises later on.
Major procedures involve dental surgery (which could involve sedation) and creating dental appliances among other things. Examples of major treatments include extractions of impacted wisdom teeth, root canals, crowns, gum surgery (Periodontal), dentures, bridges and implants, and TMJ treatment. Again some dental plans will cover these procedures starting on the effective date and others require a waiting period and meeting a yearly deductible. Why do these procedures cost more? For the same reason a gourmet meal from a fancy French restaurant costs more than a Skyline 3-Way…because of the time, training, and expertise involved.
Remember, unlike the oil, tires, or brakes on your vehicle, tooth enamel is irreplaceable. Once it’s gone, there’s no getting it back. So don’t put off those twice-yearly preventive care visits. And one more thing…if all of this talk of insurance is making your head spin, ask us about the Smile Card – our in-house discount plan for those of you who don’t have dental insurance and still want to save money…a win-win situation!
Until next time…
Dr. Greg Austria/Xenia Dentist/Bellbrook Dentist
(This article inspired by an article found in Dental Town – Agent Straight Talk, Unlocking the Mysteries of Dental Fees, June, 2016)