Answering Common
Dental Insurance Questions
What does your plan actually cover — and what will you really pay out of pocket? A procedure-by-procedure breakdown for Delta Dental, Cigna, Aetna, and Blue Cross Blue Shield patients near Houston and Katy, TX.
In This Guide
How Dental Insurance Works — The Basics
Before diving into the insurer-specific questions, it helps to understand the framework every dental PPO plan uses. The numbers differ by carrier and plan tier — but the structure is the same across Delta Dental, Cigna, Aetna, and BCBS.
Most dental insurance questions can be answered with four numbers from your plan: your annual maximum, your deductible, your coverage percentage for the procedure type, and your remaining benefits for the year. Call the member services number on the back of your card and ask for all four before scheduling any major procedure.
Delta Dental
Yes — Delta Dental PPO covers routine cleanings, comprehensive exams, and X-rays at 100% with no deductible for in-network patients. This typically includes two cleanings per calendar year and one full set of X-rays per year (bitewings every 12 months, full-mouth series every 3–5 years). There is no waiting period for preventive care — it's covered from day one of your plan.
If you're using Delta Dental Premier (out-of-network), cleanings are still covered but the reimbursement is based on Delta's "maximum plan allowance" — if your dentist charges more than that, you pay the difference. Best Dental is in-network with Delta Dental, so contracted rates apply.
Yes. Delta Dental PPO covers tooth-colored (composite) fillings as a basic procedure, typically at 70–80% after your annual deductible ($50–$100) is met. Simple amalgam fillings are covered at the same rate. Most Delta plans have no waiting period for basic restorative care — fillings are usually covered from the start of your enrollment or after a short 3-month waiting period on individual (non-employer) plans.
After deductible, Delta Dental pays 70–80% → You pay approximately $25–$52 out of pocket per filling.
Note: Delta Dental may only cover composite fillings on back teeth at the reimbursement rate for amalgam (silver) fillings. If you want tooth-colored on back teeth, check whether your plan covers composite on posterior teeth or pays the lower amalgam rate.
Yes. Delta Dental PPO covers root canals as a major procedure at 50% after your deductible. Most employer-sponsored Delta plans have no waiting period for major services; individual/marketplace Delta plans may impose a 12-month waiting period before major coverage activates.
Delta pays ~50% → Out of pocket approximately $375–$475 per tooth, after deductible. Most Houston-area dentists charge $1,200–$1,800 for a molar root canal — at those prices, your 50% share would be $600–$900.
Root canal treatment is typically followed by a crown. Delta covers the crown at 50% as well — see the crown question below for the combined cost.
Yes. Delta Dental PPO covers dental crowns as a major procedure at 50% after your deductible. Most Delta plans have a frequency limitation — crowns on the same tooth are typically only covered once every 5 years. Some plans require pre-authorization before crown placement.
Delta pays ~50% → Out of pocket approximately $475 per crown, after deductible. Root canal + crown combined: ~$950 out of pocket vs. $1,300–$1,900 at a typical Houston/Katy-area practice with the same Delta coverage.
Yes. Delta Dental covers simple extractions as a basic procedure at 70–80% after deductible. Surgical extractions (including impacted wisdom teeth) are classified as major procedures and covered at 50% after deductible. All four wisdom teeth extracted in one visit are treated as four separate procedures for coverage purposes.
Simple: Delta pays ~75% → Out of pocket approximately $63. Surgical/wisdom: Delta pays ~50% → Out of pocket approximately $125.
It depends on your specific Delta plan. Many standard employer-sponsored Delta Dental PPO plans do not include implant coverage as a standard benefit — implants were historically excluded from dental coverage and are still absent from many plan tiers. However, Delta's higher-tier plans (PPO Premium and some employer group plans) do cover implants, typically at 50% subject to a lifetime maximum and a 12-month waiting period.
If your Delta plan covers implants at 50%: Out of pocket approximately $997. If implants are excluded from your plan: Out of pocket $1,995 — or $83/mo at 0% financing over 24 months.
Always call Delta Dental member services and ask specifically: "Does my plan include dental implant coverage, and what is the lifetime maximum?" before scheduling implant treatment.
Delta Dental covers Invisalign on all plans that include orthodontic benefits — treating it identically to traditional braces. The coverage is a lifetime orthodontic maximum, typically $1,000–$2,000 depending on your plan tier. This benefit does not renew annually — once used, it's gone. Not all Delta plans include orthodontic benefits; check your Summary of Benefits.
With $1,500 Delta ortho benefit: Out of pocket $3,000. With $2,000 benefit: Out of pocket $2,500 — or $104/mo at 0% financing.
Yes. Delta Dental PPO covers full and partial dentures as a major procedure at 50% after deductible. Denture repairs are typically covered as a basic procedure at 70–80%. Most plans have a frequency limitation — full dentures on the same arch are covered once every 5 years. Immediate dentures (placed the same day as extractions) are generally covered at the same rate.
Dentures: Delta pays ~50% → Out of pocket approximately $625. Denture repairs: Delta pays ~75% → Out of pocket approximately $113.
Cigna Dental
Yes. Cigna PPO covers two routine cleanings and exams per year at 100% with no deductible for in-network patients. Full-mouth X-rays are covered once every 3–5 years; bitewing X-rays are typically covered annually. Preventive care has no waiting period on Cigna plans — it's covered from your first day of enrollment.
Yes. Cigna PPO covers tooth-colored (composite) and amalgam fillings as basic restorative procedures. Coverage is typically 50–80% after deductible, depending on your plan tier. The Cigna Dental 1500 plan covers basic services at 80% after a $50 deductible once the deductible is met. The Cigna Dental 3000 plan covers basic services at only 50% after a 6-month waiting period.
Cigna 1500 (80% basic): Out of pocket approximately $25–$35. Cigna 3000 (50% basic): Out of pocket approximately $63–$88.
Yes. Cigna PPO covers root canals as a major procedure at 50% after deductible. Most Cigna employer plans have a 6–12 month waiting period before major services are covered on new enrollments; this waiting period is often waived if you had continuous dental coverage within the previous 90 days.
Cigna pays ~50% → Out of pocket approximately $375–$475 per root canal, after deductible. Annual maximum is $1,000–$1,500 on most Cigna plans — if you need both a root canal and a crown in the same year, you may hit your annual max.
The $1,000–$1,500 annual maximum on many Cigna plans means a root canal + crown ($1,900 combined at Best Dental) could exhaust your entire year's coverage. Plan accordingly — if possible, space a root canal and crown across two calendar years to maximize benefits.
Yes. Cigna PPO covers dental crowns at 50% after deductible as a major procedure. Crowns are typically covered once every 5 years per tooth. Pre-authorization may be required on some Cigna plans before crown placement — your dentist's office handles this submission.
Cigna pays ~50% → Out of pocket approximately $475, after deductible. Root canal + crown combined: ~$950 out of pocket (before annual max is applied).
Yes. Cigna PPO covers wisdom tooth extractions, but the coverage rate depends on how the extraction is classified. Simple erupted wisdom tooth extractions are basic procedures, covered at 50–80%. Impacted (surgical) wisdom tooth extractions are major procedures, covered at 50% after deductible. All four wisdom teeth are billed as four separate procedures.
Simple extraction: Cigna pays ~80% → Out of pocket approximately $50 per tooth. Surgical/impacted: Cigna pays ~50% → Out of pocket approximately $125 per tooth. All four impacted wisdom teeth: approximately $500 out of pocket total.
Cigna's implant coverage depends on your specific plan. Many Cigna PPO plans do not cover implants as a standard benefit. Cigna's higher-tier individual plans may include implant coverage with a $2,000 lifetime maximum and a 12-month waiting period. The Cigna Dental 1500 plan typically does not include implant coverage.
If Cigna covers implants at 50%: Out of pocket approximately $997. Without implant coverage: $1,995 — or $83/mo at 0% financing over 24 months.
Call Cigna directly and ask: "Does my current plan include dental implant coverage?" and "What is the lifetime implant maximum?" before scheduling. Best Dental can also run a benefits verification for you — call (281) 215-3065.
Cigna covers Invisalign on plans that include orthodontic benefits, treating it the same as traditional braces under the lifetime orthodontic maximum. The Cigna Dental 1500 plan includes a $1,000 lifetime orthodontic maximum. Higher-tier Cigna plans may offer $1,500–$2,000. Most Cigna plans have a 12-month waiting period before orthodontic benefits activate.
With $1,000 Cigna ortho benefit: Out of pocket $3,500. With $1,500 benefit: Out of pocket $3,000 — or $125/mo at 0% financing. Learn more about Invisalign at Best Dental →
Aetna Dental
Yes. Aetna PPO covers routine cleanings, exams, and X-rays at 100% in-network with no deductible. Two cleanings per calendar year are covered, along with bitewing X-rays annually. Aetna typically covers a panoramic X-ray (full jaw) once every 3 years. No waiting period for preventive care — covered from day one.
Yes. Aetna PPO covers composite (tooth-colored) and amalgam fillings as basic procedures at 70–80% after deductible. Aetna typically has no waiting period for basic restorative services on employer plans. Individual Aetna plans may have a 6-month waiting period before basic services are covered. As with most plans, Aetna may reimburse composite fillings on back teeth at the lower amalgam rate — check your plan details.
Aetna pays 70–80% → Out of pocket approximately $25–$52 per filling, after deductible.
Yes. Aetna PPO covers root canals as major procedures at 50% after deductible. Employer-based Aetna plans often have no waiting period for major services, especially if you had prior coverage within 90 days. Some Aetna plans require pre-authorization before root canal treatment begins — your dental office submits this before the procedure.
Aetna pays ~50% → Out of pocket approximately $375–$475 per root canal. Most Houston/Katy-area practices charge $1,200–$1,800 for molar root canals — same Aetna plan, your 50% share would be $600–$900.
Yes. Aetna PPO covers dental crowns at 50% after deductible as a major procedure. Crowns are covered once per tooth every 5 years. Aetna uses an "allowable amount" system — your out-of-pocket is 50% of Aetna's contracted fee at in-network dentists, not 50% of whatever the dentist charges.
Aetna pays ~50% → Out of pocket approximately $475, after deductible. Root canal + crown combined: approximately $950 total out of pocket.
Implant coverage under Aetna varies significantly by plan. Many standard Aetna PPO plans exclude implants from coverage. Some Aetna employer group plans and Aetna's higher-tier individual plans do cover implants at 50%, typically subject to a lifetime maximum of $1,000–$2,000 per implant and a 12-month waiting period.
If Aetna covers at 50% up to $1,000: Out of pocket approximately $995–$1,495. Without implant coverage: $1,995 — or $83/mo at 0% for 24 months via Cherry or CareCredit.
Aetna has an online benefit look-up tool at aetna.com where you can check your specific plan's implant coverage before scheduling a consultation.
Yes, in some cases. Some Aetna plans cover orthodontic treatment only for dependents under 18 or 19, with adult orthodontic coverage either excluded or offered at a reduced lifetime maximum. Additionally, some Aetna individual market plans have age restrictions on certain coverage categories. Employer-sponsored Aetna plans generally cover adults and dependents equally for restorative and major procedures. Check your plan's dependent vs. member benefits separately for orthodontics specifically.
Blue Cross Blue Shield of Texas
Yes. BCBS Texas BlueCare Dental PPO covers two routine cleanings and exams per year at 100% in-network with no deductible. Bitewing X-rays are covered annually; panoramic X-rays once every 3–5 years. No waiting period for preventive care — covered from day one of the BCBS dental plan.
Yes. BCBS Texas BlueCare Dental covers fillings as basic restorative procedures at 70–80% after your annual deductible ($50–$100). Composite (tooth-colored) fillings are covered; as with most plans, posterior composite fillings may be reimbursed at the lower amalgam rate. BCBS dental plans bundled with health coverage typically have shorter waiting periods for basic services — confirm with your specific plan.
BCBS pays 70–80% → Out of pocket approximately $25–$62 per filling.
Yes. BCBS Texas PPO covers root canals as major procedures at 50% after deductible. Waiting periods for major services under BCBS dental vary by plan — employer-bundled plans often have no waiting period; standalone BlueCare Dental plans may require 6–12 months before major coverage activates.
BCBS pays ~50% → Out of pocket approximately $375–$475, after deductible. At a Houston premium practice charging $1,600 for the same molar root canal, your 50% share is $800.
Yes. BCBS Texas covers dental crowns at 50% after deductible as a major procedure. Crowns are typically covered once every 5 years per tooth. BCBS Texas uses an allowable charge schedule — the 50% is calculated on the contracted in-network rate, not on whatever the dentist's standard fee is. Using an in-network dentist ensures the contracted rate applies.
BCBS pays ~50% → Out of pocket approximately $475, after deductible.
BCBS Texas implant coverage varies considerably by plan. Standard BlueCare Dental PPO plans often have very limited or no implant coverage. Some BCBS employer group plans include implant coverage at 50% with a lifetime maximum of $1,000–$2,000 per implant. BCBS plans bundled with ACA marketplace health plans sometimes exclude implants entirely as a non-essential benefit.
If BCBS covers at 50% to a $1,000 lifetime max: Out of pocket approximately $995–$1,495. Without implant coverage: $1,995 — or $83/mo at 0% via Cherry or CareCredit.
This is one of the most important areas to verify with BCBS before beginning implant treatment. Call the number on your insurance card and ask: "Does my current BlueCare Dental plan include implant coverage, and what is the lifetime maximum per implant?"
BCBS Texas covers Invisalign on plans that include orthodontic benefits, treating it the same as braces under the lifetime orthodontic maximum. BlueCare Dental PPO standard plans include a lifetime orthodontic maximum of $1,000–$2,000 for dependents; adult orthodontic coverage varies by plan. Children under 19 are typically covered; adults may have reduced or no orthodontic benefit depending on the plan tier.
With $1,500 BCBS ortho benefit: Out of pocket $3,000. With $2,000 benefit: Out of pocket $2,500 — or $104/mo at 0% financing. Invisalign for teens →
Yes. BCBS Texas covers wisdom tooth extractions. Simple wisdom tooth extractions (fully erupted) are covered as basic procedures at 70–80%. Surgical or impacted wisdom tooth extractions are covered as major procedures at 50% after deductible. BCBS general anesthesia/IV sedation coverage for wisdom tooth surgery varies — it is covered on some plans only when performed by an oral surgeon in conjunction with a covered surgical extraction. At Best Dental, all wisdom tooth extractions of all impaction types are $250 flat — IV sedation is an optional add-on at $500 flat if needed.
Simple wisdom tooth: BCBS pays ~75% → Out of pocket approximately $63. Surgical/impacted: BCBS pays ~50% → Out of pocket approximately $125 per tooth.
Questions That Apply to All Four Insurers
IV sedation (conscious sedation administered by the dentist) is usually not covered by Delta Dental, Cigna, Aetna, or BCBS as a standalone benefit. Most dental plans cover general anesthesia only when it is medically necessary and administered by an oral surgeon — typically for complex surgical procedures like impacted wisdom teeth or extensive oral surgery. Routine IV sedation for anxiety is typically excluded from dental coverage.
For all four insurers — Delta Dental, Cigna, Aetna, and BCBS — your annual maximum resets on January 1 (or on your plan anniversary for some employer plans). Unused benefits do not roll over to the next year. If you have $800 remaining in your annual maximum and December is approaching, that $800 disappears on January 1. Scheduling any needed procedures before year-end — crowns, root canals, fillings — maximizes the value of your premiums. Best Dental can check your remaining benefits and help prioritize procedures by year-end. Call (281) 215-3065.
Yes. Both Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) can be used to pay for any dental procedure — including procedures not covered by your dental insurance, such as implants, IV sedation, or cosmetic work. FSA and HSA funds are pre-tax, meaning you pay with dollars that were never taxed — reducing your effective cost by your marginal tax rate (typically 22–32% for most Houston-area patients). Best Dental accepts FSA and HSA payments. You can also layer HSA/FSA on top of insurance — insurance covers its portion, you pay your out-of-pocket with pre-tax HSA/FSA dollars.
The most reliable method is a pre-authorization (also called a pre-treatment estimate or predetermination). Before your procedure, your dental office submits a claim to your insurer with the planned procedure codes. The insurer responds with the exact dollar amount they'll cover — a committed number, not an estimate. This tells you your precise out-of-pocket before you decide whether to proceed. Best Dental submits pre-authorizations for any major procedure before starting treatment. Call (281) 215-3065 — we verify your benefits and provide a written estimate.
For quick checks, call member services on the back of your insurance card and ask: your annual maximum, how much has been used so far this year, your deductible status, and the coverage percentage for the specific procedure type.
With a PPO (Preferred Provider Organization), you can see any licensed dentist. In-network dentists have contracted rates with your insurer, giving you lower out-of-pocket costs — but you can still see out-of-network dentists at reduced (but not zero) coverage. PPO plans have annual maximums and deductibles.
With an HMO (Health Maintenance Organization) or DHMO dental plan, you must choose a primary dentist from the insurer's network. You cannot see dentists outside that network (except in emergencies). HMO plans typically have no annual maximum and no deductible — but the network is very restrictive. Many specialty procedures may require referrals, and provider choice is very limited.
Best Dental accepts PPO plans only — not HMO, DMO, or DHMO dental plans. If you have a PPO dental plan through Delta Dental, Cigna, Aetna, or BCBS, Best Dental can use your insurance. If you're unsure whether your plan is a PPO or HMO, call the member services number on your card and ask: "Is my dental plan a PPO?"
Across all four insurers, the most commonly excluded procedures are:
- ✗ Cosmetic procedures — teeth whitening, veneers for aesthetic reasons, enamel bonding for appearance only
- ✗ Dental implants (on most standard PPO plans — verify with your plan)
- ✗ IV sedation / general anesthesia for anxiety (typically only covered for surgical cases)
- ✗ Orthodontics on plans without the orthodontic rider
- ✗ Services for congenital or cosmetic malformations
- ✗ Night guards / athletic mouth guards (on most plans)
- ✗ Procedures submitted more than 12 months after the date of service
For anything outside routine preventive care, confirming coverage before starting treatment is always worth the phone call.
Side-by-Side Coverage & Estimated Cost at Best Dental
Using Best Dental's published prices as the baseline, here's what patients on each of the four major plans typically pay out of pocket — after insurance — for the most common procedures near Houston and Katy, TX.
| Procedure | Best Dental Fee | Delta Dental OOP | Cigna OOP | Aetna OOP | BCBS TX OOP |
|---|---|---|---|---|---|
| Cleaning + Exam | Billed to insurance | $0 | $0 | $0 | $0 |
| Tooth-Colored Filling | $125–$175 | ~$25–$52 | ~$25–$88 | ~$25–$52 | ~$25–$62 |
| Root Canal (anterior) | $750 | ~$375 | ~$375 | ~$375 | ~$375 |
| Root Canal (molar) | $950 | ~$475 | ~$475 | ~$475 | ~$475 |
| Dental Crown | $950 | ~$475 | ~$475 | ~$475 | ~$475 |
| Root Canal + Crown | $1,900 | ~$950 | ~$950† | ~$950 | ~$950 |
| Tooth Extraction (simple) | $250 | ~$63 | ~$50 | ~$50–$63 | ~$63 |
| Wisdom Tooth (surgical) | $250/tooth | ~$125 | ~$125 | ~$125 | ~$125 |
| Dental Implant (complete) | $1,995 | Varies by plan | Often excluded | Often excluded | Varies by plan |
| Dentures (full) | $1,250 | ~$625 | ~$625 | ~$625 | ~$625 |
| Invisalign | $4,500 flat | $2,500–$3,500 | $3,000–$3,500 | $2,500–$3,500 | $2,500–$3,500 |
| IV Sedation | $500 | Usually excluded | Usually excluded | Usually excluded | Usually excluded |
OOP = estimated out-of-pocket after insurance. All estimates assume deductible already met and standard 50% major / 80% basic coverage tiers. † Cigna's $1,000–$1,500 annual maximum may be exhausted before both root canal and crown are covered in the same year. Actual amounts vary by plan tier — Best Dental verifies your specific benefits before treatment begins.
Using Your Insurance at Best Dental — Richmond, TX
Best Dental in Richmond, TX accepts Delta Dental PPO, Cigna PPO, Aetna PPO, and Blue Cross Blue Shield PPO — and publishes every procedure fee before you call. For Houston and Katy patients, this means you can calculate your exact out-of-pocket for any covered procedure before you ever step in the office.
Best Dental accepts PPO plans only — not HMO, DMO, or DHMO. If you're unsure whether your Delta Dental, Cigna, Aetna, or BCBS plan is a PPO, call the member services number on the back of your card and ask.
Your Insurance at Best Dental — Houston
For a deeper dive into how each plan works at Best Dental specifically — covered procedures, what to bring, and how we verify your benefits — visit your insurer's dedicated page:
Have Questions About Your Coverage?
Best Dental verifies your Delta Dental, Cigna, Aetna, or BCBS benefits before treatment begins and provides a written out-of-pocket estimate. Serving Richmond, Houston, Katy, Sugar Land, and Rosenberg. Most PPO insurance accepted.
