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Endodontics

Endodontics is a branch of dentistry focused on treating the interior of the tooth, most commonly through root canal therapy. It addresses infections, inflammation, or damage to the dental pulp and surrounding tissue. Most dental plans classify endodontics as a restorative service, meaning it typically falls under the same category as fillings and crowns.

Coverage for endodontic treatment varies by plan. Basic plans may reimburse a percentage of the cost, while comprehensive plans cover a larger portion or include higher annual maximums. Because root canals can be costly, understanding how your plan classifies and reimburses endodontic procedures is important.

Example:

If your plan reimburses 80 percent for restorative services and a root canal costs $900, your insurer pays $720 and you pay $180.

What to Watch For:

Confirm whether your plan treats endodontics as basic or major restorative. This distinction affects reimbursement percentages and waiting periods.

Related Terms

Eligible Expenses

An eligible expense is any medical or dental service, product, or treatment that qualifies for reimbursement under the terms of your insurance plan. To be eligible, the service must meet several criteria: it must be medically necessary, performed by a licensed or approved provider, and fall within the plan’s specific limits and exclusions.

Effective Date

The effective date is the day your insurance coverage officially begins. From this date forward, you are eligible to receive benefits for covered health, dental, life, or disability expenses under the terms of your policy. The effective date is established once your application has been approved, all requirements are met, and the first premium payment has been received, unless otherwise specified in the policy.

Periodontics

Periodontics is the area of dentistry concerned with the prevention, diagnosis, and treatment of gum disease and supporting bone structures around the teeth. Treatments may include deep cleaning (scaling and root planning), gum grafts, and maintenance therapy.

Orthodontics

Orthodontics covers the cost of correcting tooth alignment and jaw positioning using braces or aligners. In individual and group dental plans, orthodontic benefits are usually separate from preventive and restorative coverage. Most plans apply a lifetime maximum and a waiting period before orthodontic treatment is eligible.

Preventive / Basic Services

Preventive and basic services cover routine and common dental procedures that maintain and restore oral health. Preventive services include cleanings, X-rays, and exams, while basic services include fillings, extractions, and simple restorative work.

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