Posted by Have you ever asked how often your dental insurance covers for your X-rays? Yes, I know that’s why you are here. It is good you know so you don’t operate in ignorance.
Your dental insurance covers X-rays based on your coverage percentage and the frequency of use. In general, coverage ranges from 50-100%, and coverage for preventive care is up to 100%.
We have taken quality time to address this by explaining the types of X-rays and how frequently they are covered including bitewing, panoramic, full-mouth, and more.
Are you ready for a knowledge upscale?
Let’s go!
Table of Contents
How Often Does Dental Insurance Cover X-rays?
Most dental plans cover X-rays but it has a frequency limitation. The basic X-rays and Bitewings are usually covered once every 6 months and twice for one year while full-mouth X-rays (FMX) or paranomia X-rays might be covered for 2-5 years on a stretch.
Nevertheless, the frequency of dental insurance coverage on X-rays differs depending on the type of X-ray, the insurance plan specifics, the reason for needing X-rays, your age, and risk factors.
Here is a simple breakdown of how often dental insurance generally covers X-rays:
- The type of X-ray
- Your insurance plans
- Your age and risk factors
- The reason for needing X-rays
1. The Type of X-ray:
Just as different types of X-rays serve different purposes, dental insurance coverage for them varies accordingly.
2. Your Insurance Plan:
Specific benefits, limitations, and exclusions outlined in your policy may be different for someone else, and it will dictate the coverage frequency.
3. Your Age and Risk Factors:
Children and adults with a higher risk of dental problems may have more frequent X-ray coverage.
4. The Reason for Needing X-rays:
Diagnostic X-rays are typically covered more often than those for monitoring purposes. So the type of x-ray you need will depend on how frequently you will get coverage.
We will address this in a detailed and more comprehensive way in this article. Let’s take this ride.
You will love to read this: Does Dental Insurance Cover Oral Cancer Screening?
Types of Dental X-Rays
Below are the different types of dental X-rays and their dental coverage:
#1. Bitewing X-rays:
This is the most common type of X-ray, which shows the upper and lower back teeth side-by-side.
- Coverage: Most plans cover bitewings once or twice a year.
- Reasoning: Bitewing X-rays help detect cavities between teeth early on, saving you money and pain in the long run.
#2. Periapical X-rays:
This type of X-ray focuses on a single tooth and its surrounding bone.
- Coverage: It is less frequent than bitewings, but it is typically covered when medically necessary.
- Reasoning: Periapical X-rays are used frequently to diagnose problems under a crown or in the root of a tooth.
#3. Full-mouth series (FMX) or Panoramic X-rays:
This type of x-ray shows all the teeth and surrounding bone structures in one image.
- Coverage: It is usually covered every 2 to 5 years, depending on your dental insurance plan and individual needs.
- Reasoning: It is useful for diagnosing hidden problems or planning complex dental procedures.
#4. Cephalometric X-rays:
This is a dental X-ray that shows the side profile of the jaw and head.
- Coverage: It is covered mostly when planning orthodontic treatment or diagnosing jaw alignment issues.
- Reasoning: Cephalometric X-rays are not used in routine dental care.
Check this out: Does Dental Insurance Cover X-rays?
How The Types Of X-rays Determine The Frequency Of Dental Insurance Coverage:
Below is a comprehensive breakdown of how often dental insurance covers your type of x-ray:
-
Bitewing X-rays:
The frequency of an average dental insurance coverage for bitewing X-rays is once or twice a year. Basic dental plans are mostly limited to once a year. Premium dental plans may offer two sets of bitewing X-rays per year or even full coverage with no frequency limit.
-
Periapical X-rays:
The frequency average coverage: Periapical X-rays are only covered by dental insurance when medically necessary (For example, diagnosing crown issues).
Basic and premium dental plans have a similar frequency of dental insurance coverage, focusing on medical necessity rather than frequency.
-
Full-mouth series (FMX) or Panoramic X-rays:
The frequency of dental insurance coverage for full-mouth series X-rays ranges from 2 to 5 years. Basic dental plans usually have longer intervals like up to 5 years or limited coverage.
However, Premium dental insurance plans have shorter intervals like about 2-3 years or even annual coverage.
-
Cephalometric X-rays:
Cephalometric X-rays are only covered if needed for orthodontic treatment or jaw alignment diagnosis. Basic and premium dental plans have similar coverage, focusing mainly on specific treatment planning needs.
Read Also: Does Dental Insurance Cover Sealant?
Additional Factors Influencing The Frequency of Dental Insurance Coverage For X-rays
- Age: Children and adolescents often require more frequent bitewing X-rays due to developing teeth.
- Medical history: Individuals with a higher risk of dental problems (e.g., existing cavities) might see more frequent X-rays, regardless of plan level.
- Plan specifics: Always check your plan details for exact coverage, co-pays, and deductibles.
Scenarios Where Dental Coverage For X-rays Might Not Apply:
How often dental insurance will cover X-rays depends on the type of x-ray, the insurance plan specifics, and other factors. However, there are still exceptions to coverage for X-rays.
Below are some exceptions and limitations to dental insurance coverage for your X-rays:
1. Excessive X-rays:
Insurance companies may deny you coverage for X-rays that were deemed unnecessary by your dentist or exceed the allowed frequency in your plan. This could include:
- X-rays are taken at shorter intervals than recommended without justification.
- Multiple x-rays of the same area for the same issue without a clear clinical reason.
- Obtaining x-rays solely for cost estimation purposes before committing to treatment.
2. Pre-existing Conditions:
Coverage for some of your X-rays related to pre-existing conditions might be limited or excluded altogether. Examples of these include:
- X-rays related to a condition diagnosed before your insurance policy started.
- X-rays for issues identified during your initial exam when determining pre-existing conditions.
- Ongoing monitoring of a pre-existing condition exceeding the designated frequency in your plan.
Out Of Pocket Costs Associated With X-ray Coverage
While dental insurance provides valuable coverage for X-rays, it is crucial to understand your plan’s limitations and navigate potential out-of-pocket costs. Here’s how:
1. Uncovered X-rays:
If you exceed your plan’s frequency limits, require x-rays deemed unnecessary, or experience pre-existing condition limitations, expect to pay the full cost, which can range from:
- Bitewing X-rays: $30 – $75 per set
- Periapical X-rays: $25 – $50 per tooth
- Full-mouth series: $100 – $200
- Panoramic X-rays: $100 – $200
- Cephalometric X-rays: $150 – $300
2. Deductibles and Co-pays:
Even if you are covered for X-rays, you might face:
- Deductibles: This is a fixed amount you pay before insurance kicks in (e.g., $50 per year).
- Co-pays: These are fixed fees you pay per covered service (e.g., $10 per bitewing set).
Read Also: Does Dental Insurance Cover Sedation?
Affordable Alternatives Options For X-Ray Coverage
Here are quite affordable options you can consider for your X-ray coverage:
- Negotiation:
Set out to discuss potential discounts with your dentist, especially for bundled services or upfront payments.
- Membership Plans:
Try considering dental membership plans with included x-rays, often for a monthly fee.
- Community Health Centers:
These centers offer subsidized or free X-rays to qualifying individuals.
Tips for Maximizing Dental Insurance Coverage Benefits For X-rays
Consider the following tips to help you maximize your coverage benefits:
1. Schedule For Routine Checkups:
Most plans automatically include bitewing X-rays with your regular cleanings, so maximize your coverage by keeping up with appointments.
2. Know Your Plan Inside Out:
Take time to understand your specific plan details, including limitations on frequency and types of X-rays covered.
3. Talk to Your Dentist:
Before any X-ray, discuss your needs and budget with your dentist. They can recommend the most cost-effective options based on your plan and any pre-existing conditions.
Companies That Offer Insurance Coverage For X-rays:
Frequently Asked Questions
[sc_fs_multi_faq headline-0=”h3″ question-0=”How often does insurance cover bitewing X-rays?” answer-0=”Most dental insurance plans cover bitewing X-rays once or twice a year, often as part of your preventive care coverage. This helps catch cavities early and avoid costly treatments later. However, coverage for bitewings can vary depending on your specific plan. Check your plan details or contact your insurance provider to confirm the frequency and co-pay amount.” image-0=”” headline-1=”h3″ question-1=”What about panoramic X-rays?” answer-1=”Panoramic X-rays are usually covered every 2-5 years, depending on your plan and dental needs. Some might require them more frequently for orthodontic work or wisdom teeth monitoring. While other basic plans might not cover panoramic X-rays at all. Be prepared for potential out-of-pocket costs depending on your plan and reason for requiring it.” image-1=”” headline-2=”h3″ question-2=”Do I need X-rays every time I visit the dentist?” answer-2=”No, not necessarily. Routine checkups might not always require X-rays if your dentist can visually assess your teeth. Discuss your situation and concerns with your dentist to determine if X-rays are needed. Additional X-rays might be needed if you experience pain, swelling, or a suspected dental issue. Your dentist will advise you based on your symptoms and dental history.” image-2=”” headline-3=”h3″ question-3=”Can I get extra X-rays if my plan doesn’t cover them?” answer-3=”Some dentists offer discounted rates for out-of-pocket X-rays. Discuss options and costs with your dentist before proceeding if your plan doesn’t cover them. Additional X-rays can add up financially. Consider consulting your dentist about alternative diagnostic methods if insurance coverage is limited.” image-3=”” headline-4=”h3″ question-4=”What if I don’t have dental insurance?” answer-4=”Without insurance, X-rays can be costly. Consider alternative options like dental schools or clinics offering lower rates. You can also research discount dental plans for more affordable coverage. However, taking good care of your oral hygiene can help minimize the need for frequent X-rays. Regular brushing, flossing, and dental checkups can often prevent dental issues requiring extensive diagnosis.” image-4=”” count=”5″ html=”true” css_class=””]
Important Recommendation
- Does Dental Insurance Cover Retainers?
- Does Dental Insurance Cover Second Opinions?
- Does Dental Insurance Cover Deep Cleaning?
- Does Dental Insurance Cover Bonding?
- Does Dental Insurance Cover Gum Grafts?
Conclusion
To ensure you receive the appropriate X-ray coverage for your dental needs, it is good that you actively review your dental insurance plan documents to understand your specific X-ray coverage, which includes frequency, limitations, and out-of-pocket costs.
Consult your dentist frequently and discuss your oral health issues. They can recommend the most appropriate X-ray schedule based on your unique needs.
Thanks For The Read!