Insurance Information

The best way to confirm your coverage and out-of-pocket costs is to contact your insurance provider directly. If you’d prefer help, our team is happy to assist. Simply share your insurance carrier and subscriber ID, and we can help review your benefits and explain how they apply to your care.

When a provider is in-network, it means they have a direct contract with your insurance company and offer pre-negotiated fees.

If we are out-of-network, there is no direct contract, but we still accept your insurance. In this case, services are billed at our standard fees, and your insurance applies coverage based on your out-of-network benefits to determine your portion of the cost.

We accept most major PPO insurance plans but are not contracted with Denti-Cal, Medi-Cal, or HMO plans.

Dental insurance works similarly to medical and vision insurance and is often provided through employers. It typically includes monthly premiums, preferred providers, and defined benefit guidelines.

One key difference is that dental insurance has an annual maximum—a limit on how much the plan will pay each year. Medical insurance, on the other hand, usually begins covering most costs once you reach your out-of-pocket maximum.

Dental insurance helps cover the cost of care up to a set limit within a benefit period, usually one year. Once that annual maximum is reached, any remaining costs become the patient’s responsibility.

Most PPO plans group services into three categories:

Most dental insurance plans help cover services such as exams, cleanings, fillings, crowns, oral surgery, and sometimes orthodontics. Coverage depends on whether the procedure is considered preventive, basic, or major, and patients are responsible for any portion not covered by insurance.

Orthodontic benefits vary widely and may include age restrictions, limited eligibility, and lifetime maximums instead of annual limits.

A PPO (Preferred Provider Organization) dental plan allows you to choose your dentist without needing a primary care referral. You can visit specialists directly, and you’ll typically save more when you see in-network providers who have pre-negotiated fees with your insurance company.

By comparison, HMO or DHMO plans are designed for lower-cost care and usually require you to select a primary dentist. Specialist visits generally need a referral, and care is limited to the assigned network or facility.

Most PPO dental plans cover two routine exams and cleanings per calendar year as part of preventive care.

In many cases, dental insurance may help cover implant-related procedures. Coverage depends on your specific plan and may include certain exclusions or limitations—such as a “missing tooth clause,” which can affect coverage if the tooth was missing before your policy began.

We’re happy to help review your plan and explain how your benefits may apply to implant treatment.

Many dental insurance plans offer orthodontic coverage, including treatments like Invisalign, but restrictions often apply. These may include age limits, eligible beneficiaries, and maximum benefit amounts.

Unlike other dental services, orthodontic benefits are commonly subject to a lifetime maximum rather than an annual limit. Our team can help you understand the details of your specific coverage.