Dental insurance isn’t really insurance. True insurance (fire, life, homeowner’s, even medical) protects you against rare, very expensive events: many people pay small premiums, and the few who suffer a loss are paid. Dental care isn’t rare. According to the CDC, more than 85% of adults and 45% of U.S. children get cavities, the most common chronic disease of childhood. So dental insurance, introduced in the 1960s as an employer benefit, works more like a dental benefit, usually capped at $1,000–$2,000 per year.

Because of those caps, most plans focus on cleanings and repairs like fillings and crowns, a treatment model rather than a wellness model, even though plans with better preventive coverage exist.

“Not covered” doesn’t mean “not needed.” Many patients assume their benefit covers everything they need, and that anything else is optional. For example, a patient with four cavities and gum disease may need all four fillings, gum treatment and antibacterial therapy, but their benefit may cover only two fillings. Untreated cavities and gum infections don’t heal on their own. Letting a benefit cap decide treatment lets the disease get worse and more expensive, sometimes until teeth have to be removed.

Dental insurance is a product. Coverage is packaged into policies sold to employers and individuals, designed to:

• Be profitable for the insurance company
• Meet the price employers, employees and individuals expect to pay
• Pay dental practices adequately for procedures

CAMBRA coverage: Some insurers do cover CAMBRA-related codes, such as D0425 (caries susceptibility testing), D1206 (fluoride varnish for moderate- or high-risk patients), D1310 (nutritional counseling) and D9630 (medications or fluoride dispensed for home use). But if a plan doesn’t cover a therapy your dentist recommends, that doesn’t make it unnecessary. Ask yourself who cares more about your child’s dental health: your insurance company or your dentist?

*Cavities are the most common chronic disease of childhood in the United States. Untreated, they can cause pain and infections that affect eating, speaking, playing and learning, and children with poor oral health miss more school and get lower grades.

• More than half of children aged 6 to 8 have had a cavity in a baby tooth.
• More than half of teens aged 12 to 19 have had a cavity in a permanent tooth.
• Children aged 5 to 19 from low-income families are twice as likely to have cavities (25%) as those from higher-income households (11%).

Sources:
https://www.cdc.gov/oral-health/prevention/oral-health-tips-for-children.html
https://www.nidcr.nih.gov/research/data-statistics/dental-caries/children