In dental insurance, 100-80-50 is shorthand for how much the plan pays for three tiers of care: preventive, basic and major. Read it as 100 percent of preventive care, 80 percent of basic care and 50 percent of major care, after any deductible and only up to your annual maximum. The numbers are a starting point, though. Which tier a service falls into, and the rules around each, decide what you actually owe.
Each number is the plan's share of the allowed fee for a service, which is the amount the plan recognizes for that procedure. Your share, called coinsurance, is whatever is left. So in a 100-80-50 plan, you would typically owe nothing for a covered cleaning, a fifth of the allowed fee for a covered filling, and half of it for a covered crown, once any deductible has been met.
Some plans use other splits, such as 100-70-50 or 90-80-50, and some managed-care plans use fixed copays instead of percentages. The idea is the same: routine care is encouraged, larger work is shared more evenly.
Plans write their own lists, so the same procedure can sit in a different tier on two plans. This is the common pattern:
| Tier | Usually includes | Watch for |
|---|---|---|
| Preventive (the 100) | Exams, routine cleanings, routine X-rays, fluoride for children, sometimes sealants | Limits on how often; extra cleanings or X-rays may not count |
| Basic (the 80) | Fillings, simple extractions, emergency exams; on many plans root canals and deep cleanings | Some plans move root canals, gum treatment or surgical extractions to major |
| Major (the 50) | Crowns, bridges, dentures, and implants on plans that include them | Waiting periods, replacement limits and exclusions are most common here |
| Often separate or excluded | Orthodontics, cosmetic work such as whitening or veneers | Orthodontics may have its own lifetime maximum; cosmetic care is usually not covered |
When you see a treatment plan, ask which tier each line falls under on your plan. Our guide to reading a dental treatment plan shows how to line items up.
These rules explain most "but my plan says 80" surprises. A filling may be in the 80 tier, but if the deductible has not been met, the visit counts it first.
An in-network dentist has agreed to the plan's fee schedule. The percentages apply to that agreed fee, and the dentist does not bill you above it for covered services.
Out of network, the plan applies its percentage to its own allowed amount, which may be lower than the office's fee. Depending on the plan, you may owe the coinsurance plus the difference between the two, often called balance billing. Some plans, especially managed-care ones, pay nothing outside their network except in emergencies. Before your first visit anywhere, ask whether the office is in network with your specific plan, not just the insurance company.
For larger treatment, the office can send the plan a predetermination (also called a pre-treatment estimate). The plan replies with what it expects to pay, based on your benefits at that moment. It is not a promise of payment: if you use part of your maximum elsewhere, change plans or the treatment changes, the final payment can differ. It can also take a few weeks to come back, so ask early if timing matters.
After any claim, the plan sends an Explanation of Benefits (EOB). It is not a bill. It shows the allowed fee, what the plan paid, what went to the deductible and what remains your share. Comparing it with the office's statement is the easiest way to catch a mismatch.
We accept most major dental insurance. Before treatment, our team looks up your tiers, deductible, remaining maximum, frequency limits and waiting periods, and the exact price is confirmed in writing, with the estimated plan payment and your share shown separately. Starting prices are on our pricing page, and for the part a plan does not cover, we offer 0% financing options on approved credit through CareCredit, Cherry and LendingClub. Our post on finding a dentist that accepts insurance covers what to ask any office. We check your benefits for you.
Dr. Aakash Rana, DDS is a general dentist trained at NYU College of Dentistry, with more than $100,000 in continuing education. He plans and treats each case at Prana Dental himself, works with our in-house lab, and refers to a specialist when a case needs one.
It describes how much the plan pays for preventive, basic and major care: the full allowed fee for preventive, most of it for basic and about half for major. You pay the remainder, after any deductible and up to the annual maximum.
It depends on the plan. Many plans list root canals as basic services, while others place them under major. Check your plan's benefit summary or ask the office to look it up before treatment.
On many plans, yes: crowns, bridges and dentures are usually major services, paid at the lowest percentage and often subject to waiting periods and replacement limits. Some plans cover them differently, so confirm with yours.
Often not. Many plans waive the deductible for preventive care such as exams and cleanings. Basic and major services usually require the deductible to be met first.
Only within the plan's rules. If you go more often than the frequency limit, need a different type of cleaning, or see an out-of-network dentist, you may owe part of the fee. Check your limits before booking an extra visit.
Call or text (786) 579-0521 with your plan details and we will look it up. We're open, Monday to Saturday, 8am to 8pm.