What medical plans will pay for in dental operations ?

Medical plans will pay for:

• Treatment related to inflammation and infection.
• Dental repair of teeth due to injury.
• Exams for orofacial medical problems.
• Extraction of wisdom teeth, under certain conditions.
• Extraction of multiple teeth at one time.
• Certain periodontal surgery procedures.
• Consultation for and excisional biopsy of oral lesions.
• Consultation and treatment for temporomandibular joint problems.
• Infection that is beyond the tooth apex and not treatable by entry through the tooth.
• Pathology that involves soft or hard tissue.
• Procedures to correct dysfunction.
• Emergency trauma procedures.
• Appliances for mandibular repositioning and/or sleep apnea.
• Congenital defects.

Medical and dental benefit designs are determined by the insurance company and the plan sponsor, which is usually an employer purchasing coverage for employees. Many plan sponsors want specific oral surgical procedures paid under their medical benefit plan. Coverage by the medical policy allows the preservation of dental plan benefits, which generally have a low annual maximum compared to medical plans. Under a medical plan's coverage, dental care can be accessed without exhausting the dental plan's annual maximum in one surgical appointment.