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  • Writer's pictureThe Tooth Doctors

What's the deal with Dental Insurance?

Updated: Jan 18, 2022

We know, it's everyone's MOST favourite subject! DENTAL INSURANCE! We can hear you from over here, getting all excited to learn more about dental insurance.

Why Do We Even Talk About It?

Why do dental offices seem obsessed about blogging about dental insurance? It's because we talk about it everyday and we think everyone else is just as excited about it as we are. Hee hee. No, really because it is a subject that many people don't really know much about and we think it's important because the more you know, the better choices you are able to make. We'll try to break it down for you in a super fun exciting way!

All You Need to Know About Dental Insurance

So, in the olden days, like the 70s, dental insurance was much different. It covered a much more significant portion of your dental visits. Today, studies have shown that insurance hasn't even kept up with inflation. Every year insurance companies are covering less and less.

We've actually noticed quite a few changes in insurance in the last few months. Check your plan, it might have changed.

The other thing about dental insurance is it really doesn't have much to do with your dentist at all. Christine and Jenn sometimes get blamed by patients for how much their insurance covers but it is your employer who's picked the plan for you.

Sometimes insurance companies won't tell us what you are covered for. At The Tooth Doctors, we do as much as we can to make sure you don't have to pay out of pocket. We find out your coverage so we can optimize your treatment plan. (Side Note: we ALWAYS recommend the treatment that is BEST for you and try to fit it in your insurance plan as much as possible. We don't recommend treatment that is best for your insurance plan. It's always about what's best for you and we hope your insurance works with it). While we do our best to know how often you are covered for a recall exam, sometimes insurance companies won't talk to us - they will only talk to you. You can find out your dental plan coverage and let us know. If we know, we are able to schedule you in appropriately.

Do You Have A Good Plan?

Want to know if you have a good plan? You can check your plan coverage. All estimations of a good plan will ALWAYS depend on your specific needs. You may need more or less than we are pointing out. You can always talk to Christine about your plan and she can let you know more, especially in regards to your own oral health.


  • How often are you covered to come in for a check up (recall) exam? We love seeing you at least 2x per year but again, it will depend on your circumstances.

  • How many scaling units do you have? Scaling (cleaning) is billed based on time spent with your hygienist.

  • Are you covered for tooth colored fillings? Many plans still only cover the fees up to which they would pay for amalgam fillings on molars (those are the silver mercury ones). Check if your plan covers white fillings, as that's all we do in our office.

  • How often can you have a complete oral exam? Your plan will tell you how often you can come in for these. Our standard of care is to do a complete oral exam when you become a new patient and another one at least every 5 years.

  • How often can you get X-Rays? We have a few different x-rays. Check-up/cavity detecting xrays (bitewings), we like to take at least every 18 months for adults and 12 months for children once their 6 year old molars have erupted. A full mouth x-ray (panoramic) we do with your complete oral exam, or as indicated.

  • What percentage are you covered for? Most insurance companies breakdown services into two categories: 1. Basic: Includes your exams, cleaning, polishing, fluoride, x-rays, fillings, and extractions. 2. Major: Includes things like crowns and bridges. Ideally, you could be covered at 100% for these services. Many insurance companies do provide 100% coverage for basic but it's not as common for major services. Check to see what percentage you are covered for.

  • Sometimes insurance companies say your plan covers 100% of your basic services but not at the current year fees. They may pay based on the previous year fees (a 1 year lag), or at the fees of a specified year. Each year the Ontario Dental Association sends dentists a guide on what to charge for their services. Most dentists follow this fee guide, us included. However, the fee guides from years past don't have the same prices. This means you might be covered for 100% but still have a copay amount because you are being covered at 100% of a fee that has since increased. Your plan will tell you which year's fee guide you are covered for.

  • Plan maximums. Most plans have a max number of dollars that you are covered for each policy year. You can only spend up to a certain amount and then you are not covered anymore. This is where insurance companies haven't even kept up with inflation. Check to see your maximums. You may have 3 different maximums. One for basic, one for major and one for orthodontics.

  • Speaking of orthodontics, this has a percentage too! You can check your plan to find the percentage you are covered for orthodontics.

  • Children or dependants are another thing you need to check for on your insurance plan. Are they covered? Do they have different coverage than you do? This is often the case. We have noticed insurance companies cutting preventative services for children lately.

There! Completely de-mystified. No? Don't worry if you are still confused. We are happy to help with your insurance questions. We've also included a form! It's the guide we follow when talking to insurance companies and we are sharing it with you! Shhh! Don't let them know!

dental plan breakdown
Download PDF • 77KB




We had such an amazing response from the 12 - well it actually turned out to be 16- days of giveaways! As always, it's very fun to host this epic giveaway but it's even more fun to be able to work with so many amazing people. A HUGE thanks to each and every one of you who participated! Especially to those small businesses who were so graciously involved in it!

We know we missed some people! If you are wanting to participate next year, please email us around the beginning of November. It may look a little different next time but we will see...




We want to assure you that we are still open and operating during this lockdown. We have 4 team members with school children so we are working around schedules. It may mean moving around a few appointments. This also means it's vital you call us as far in advance if you have to reschedule. We hope you stay well! And as always, under the learn tab, there are resources for learning for young children! They are available to anyone who wishes to use them


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