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Dental Insurance: A Simple, Comprehensive Guide to Coverage, Costs, and What to Expect

Dental insurance is one of the most practical forms of coverage available because it helps people manage both routine dental care and the cost of unexpected dental problems. In most cases, plans help pay for cleanings, exams, fillings, and major procedures like crowns or root canals—reducing out-of-pocket costs and making preventive care easier to maintain.

With that in mind, this guide explains how dental insurance works, what it typically covers, why it matters, and what to know if you’re applying for an individual or family plan.

What Is Dental Insurance?

Dental insurance is designed to help pay for a wide range of dental services, including:

  • Preventive care (cleanings, exams, X-rays)

  • Basic care (fillings, simple extractions)

  • Major services (crowns, root canals, dentures)

  • Sometimes orthodontics (braces or aligners)

However, unlike medical insurance, dental insurance usually includes an annual maximum benefit, meaning the plan only pays up to a set dollar amount each year. Once that amount is reached, the remaining cost becomes the insured’s responsibility until the plan renews.

Why Dental Insurance Matters

Dental insurance matters for two main reasons:

1. It Encourages Preventive Care

To start, people with dental insurance are significantly more likely to schedule routine cleanings and exams. As a result, dental issues are often discovered early—before they become painful, complicated, or expensive.

2. It Reduces the Cost of Major Dental Work

On the other hand, major dental problems can become financially overwhelming without coverage. Even a single procedure, such as a crown or root canal, can cost hundreds or thousands of dollars. Dental insurance helps share that cost, which makes treatment more manageable and easier to plan for.

What Dental Insurance Typically Covers

Most dental plans break coverage into three service categories. Although exact coverage varies by carrier and plan type, the structure is usually consistent.

✅ 1. Preventive Care (Often Covered 100%)

Preventive care is usually covered at the highest level and commonly includes:

  • Exams (often 2 per year)

  • Cleanings (often 2 per year)

  • X-rays (commonly once per year)

Because preventive care is designed to reduce long-term dental risk, it often comes with the most generous coverage level. In other words, insurance companies want members to stay consistent with routine visits because it reduces future claims.

✅ 2. Basic Services (Often Covered 70%–80%)

Next, basic services generally include:

  • Fillings

  • Simple extractions

  • Deep cleanings (gum therapy)

  • Minor repairs

Since these services are more expensive than routine cleanings, they are typically covered at a slightly lower percentage than preventive care.

✅ 3. Major Services (Often Covered 40%–60%)

Finally, major services usually include:

  • Crowns

  • Root canals

  • Bridges

  • Dentures

  • Oral surgery

In many cases, major services are also subject to waiting periods, depending on the plan. Therefore, it’s important to review plan details before enrolling—especially if major work is anticipated.

Key Dental Insurance Terms to Understand

Understanding these terms makes it much easier to compare plans and avoid surprises later.

Annual Maximum

Most plans include an annual maximum (commonly $1,000–$2,000). Once the plan pays that amount, the insured pays the remaining costs until the plan renews.

Deductible

A deductible is the amount paid before benefits apply for most non-preventive services. That said, preventive care is often covered without applying the deductible.

Waiting Period

Some services—especially major procedures—may require a waiting period before coverage applies. Fortunately, preventive services are usually covered immediately.

Network (In-Network vs. Out-of-Network)

If a dentist is in-network, the plan usually provides discounted pricing. As a result, insureds typically pay less out of pocket. Meanwhile, out-of-network providers may charge higher fees, which can increase the insured’s share.

Delta Dental of South Dakota: 2026 Individual & Family Plans™ (Extra Value Built In)

Delta Dental offers individual and family dental plans designed to make dental care easier and more affordable for South Dakota residents. In addition to standard coverage, these plans include built-in value programs that help members get more out of their benefits.

Who Is Eligible to Apply?

✅ Permanent South Dakota residents over age 19 may purchase an individual dental plan.

What Are the Payment Options?

Delta Dental offers several flexible payment methods:

  • Monthly payment by credit card

  • Monthly payment by EFT

  • Annual payment by check

When Does Coverage Start?

In most cases, individual plans begin:

✅ On the first day of the month after the application and payment are received,
with some services subject to waiting periods.

Because waiting periods vary by plan, reviewing the benefits summary before enrolling is strongly recommended.

Extra Value Programs Included

Health through Oral Wellness® (HTOW)

Delta Dental includes a program called Health through Oral Wellness (HTOW). Members may qualify for additional benefits based on their oral health risk level, which is determined through a risk assessment completed during a regular dental visit.

For example, members who are more prone to gum disease may receive expanded support through this program.

Prevention Pays

Delta Dental’s Prevention Pays program allows routine preventive services to go further.

✅ Exams, cleanings, and X-rays do not count toward the annual maximum, which helps members preserve their annual max for major procedures later in the year.

As a result, members may get more value from their plan without sacrificing benefits for larger services.

Find a Dentist: Strong Network Access

Delta Dental offers one of the largest dental networks available. That network strength can translate into lower out-of-pocket costs and easier access to care.

  • 95% of dentists in South Dakota are in-network

  • 4 out of 5 dentists nationwide are in-network

Because in-network dentists agree to contracted pricing, members typically experience:

  • Lower costs

  • No balance billing

  • Less time spent searching for a provider

Final Thoughts: Dental Insurance Is One of the Most Practical Coverages You Can Buy

Dental insurance helps people stay ahead of dental problems instead of reacting once pain or major costs show up. Over time, consistent preventive care leads to earlier issue detection, simpler treatment, and fewer high-cost dental emergencies.

For individuals and families looking for predictable costs and strong dentist access, plans like Delta Dental of South Dakota can provide meaningful value—especially with built-in programs like Prevention Pays and Health through Oral Wellness.

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