Pondfield family dental

Table of Contents

1. What Does Dental Insurance Typically Cover?

2. Preventive Care: Don’t Skip What’s Already Covered

3. Fillings, Crowns, and Root Canals: What’s the Real Cost?

4. Dental Implants: Are They Ever Covered?

5. Cosmetic Dentistry: What’s Considered “Necessary” vs. “Aesthetic”

6. Medicare, Medicaid & Retiree Plans in Bronxville

7. Hidden Costs: Annual Maximums, Deductibles & Fine Print

8. How We Help at Pondfield Family Dental Care

9. FAQs

From implants to cleanings—here’s the truth about what your dental insurance actually pays for (and what it doesn’t).

As a local dentist at Pondfield Family Dental Care in Bronxville, one of the most common questions I hear is: "Will my insurance cover this?" Whether it’s a routine cleaning, a crown, or a dental implant, the answer isn’t always straightforward.

In this article, we’ll break down what your dental insurance likely covers, what it doesn’t, and how we help patients from Bronxville, Eastchester, Yonkers, and beyond make the most of their benefits—without surprises at checkout.

What Does Dental Insurance Typically Cover?

Most dental insurance plans follow a structure known as 100-80-50:

• 100% coverage for preventive care (exams, cleanings, x-rays)

• 80% coverage for basic care (fillings, simple extractions)

• 50% coverage for major care (crowns, root canals, bridges)

However, not all plans are created equal. Every policy has its quirks. For example, some consider a root canal basic, while others label it major. That difference matters—especially when it comes to out-of-pocket costs.

At our office, we make it a priority to review each patient’s plan before treatment. We’ll check your annual maximum, whether a waiting period applies, and ensure you know exactly what to expect.

Preventive Care: Don’t Skip What’s Already Covered

Preventive care is the foundation of every dental insurance plan—and it’s usually 100% covered. That includes two cleanings a year, your exams, and diagnostic x-rays.

We often see patients who didn’t realize these benefits were free. One Bronxville mom recently told us she delayed her cleaning for months, thinking it would be expensive. When she found out it was fully covered, she was relieved—and now she never misses a visit.

Learn more about our preventive care services

Fillings, Crowns, and Root Canals: What’s the Real Cost?

Fillings are typically covered at 80%, but only certain materials might qualify. Some plans still cover silver amalgam more than tooth-colored composite, which many Bronxville patients prefer.

Crowns and root canals, on the other hand, are usually considered major procedures and fall into the 50% coverage range. Add in a $1,500 annual limit, and it’s easy to run out of benefits fast.

Explore our restorative dental options

Dental Implants: Are They Ever Covered?

Dental implants are one of the most requested services we provide—and one of the most misunderstood when it comes to coverage. In general, most standard dental plans do not cover implants unless there’s a documented medical necessity (such as traumatic tooth loss). Some upgraded PPOs or employer-sponsored plans may offer partial benefits.

If you’re unsure, we’ll send a pre-authorization request to your insurance provider and help you fight for coverage if it’s denied. We’ve done this for many Bronxville and Eastchester patients with positive results.

Learn more about dental implants

Cosmetic Dentistry: What’s Considered “Necessary” vs. “Aesthetic”

Most cosmetic procedures—like teeth whitening, veneers, and elective bonding—aren’t covered by insurance because they’re considered optional. However, there are gray areas. If you chip a front tooth and need bonding or a crown to restore function or prevent further damage, your insurance might step in. It all depends on how the claim is presented.

Check out our cosmetic dental services

Medicare, Medicaid & Retiree Plans in Bronxville

Here’s where things get a little more nuanced:

• Original Medicare does not cover dental care. No cleanings, no fillings, no dentures.

• Medicare Advantage plans (Part C) often include dental benefits, but coverage varies widely. Some include two cleanings per year and basic procedures, while others offer more.

• New York State Medicaid does offer dental coverage, including checkups, fillings, extractions, and even dentures in some cases. However, access to providers who accept Medicaid may be limited.

We help many seniors in Bronxville and Yonkers understand what’s available under their current plan. Bring your insurance card—we’ll take it from there.

Hidden Costs: Annual Maximums, Deductibles & Fine Print

Even if your plan says it covers 80% or 50%, it likely has an annual benefit cap—usually between $1,000 and $1,500. Once that’s used up, you’re responsible for the rest.

Waiting periods are another issue. New plans may delay coverage for crowns or root canals for 6–12 months.

We always factor these limits into our treatment plans so you don’t get hit with unexpected costs.

How We Help at Pondfield Family Dental Care

We know insurance is confusing. That’s why our team goes above and beyond to simplify it. Here’s how we help:

• We verify your benefits before you sit in the chair

• We explain your out-of-pocket costs before treatment

• We submit claims and handle follow-ups

• We assist with appeals when coverage is denied

We also work with most major providers, including Delta Dental, MetLife, Aetna, and Cigna.

FAQs

Does dental insurance cover implants?

Not usually—but some plans offer partial coverage if implants are medically necessary. We verify every case individually.

Is cosmetic dentistry covered?

Generally no, unless the procedure restores function after trauma. We’ll help determine if your situation qualifies.

Can I use my HSA or FSA for dental work?

Yes. Most medically necessary dental treatments are eligible, including implants, crowns, and root canals.

What if I don’t have dental insurance?

We offer flexible payment plans and an in-house membership plan with preventive care and treatment discounts.

Final Thoughts

Dental insurance should give you peace of mind—not anxiety. If you’re unsure what your plan covers, don’t wait until you're in the chair. Send us a photo of your card or give us a call before your next visit. We’ll walk you through it all so you can feel confident—both in your treatment and your budget.

Whether you're coming from Bronxville, Mount Vernon, or just around the corner in Eastchester, we're here to help you smile smarter.

Request an appointment today.