Does Dental Insurance Cover X-Rays?

A dental X-ray is often the first step to diagnose tooth decay — and prevent complications. The average cost of dental X-rays can vary widely. The amount covered by your dental insurance plan and the degree of coverage can depend on many factors, such as the policy and the category of the dental X-rays. This article will explore if dental insurance covers the cost of dental X-rays, at what percentages, and how to maximize your coverage.

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What are dental X-rays?

Dental X-rays are images of your mouth and jaw. Sometimes, it can include facial hard structures too (bones and sinuses). Dentists often advise getting an X-ray done as part of preventive oral care. They also use it as a diagnostic tool to identify potential oral health issues.

There are different types of dental X-rays, and each serves a different purpose. Here is a list of the common ones.

Bitewing

Bitewing X-rays are the most common type of intraoral X-rays that capture any cavity or anomaly across the interdental space — between two teeth. A single bitewing X-ray will show your upper and lower teeth in a particular area. It helps detect interproximal caries and jaw bone heights below the gums.

Periapical

These are another common type of intraoral X-rays that capture an entire tooth from the crown to the root and the surrounding structures beyond the root tip. Periapical dental X-rays help detect any cyst, tumor, or abscess related to the root tip.

Panoramic

Also known as Orthopantomograms (OPGs), panoramic dental X-rays cover the whole jaw (set of teeth) and the entire mouth. They help diagnose jaw lesions, impacted teeth inside gums, expanding jaw bone tumors, and oral cancers.

Cephalogram

These extraoral X-rays capture a side view of your jaws and face. They measure your upper or lower teeth relations, which helps orthodontists plan treatment. An orthodontist can advise a cephalogram throughout different phases of treatment to understand the improvements.

You might need one or more frequent X-rays depending on your oral health issue. It's best to talk to your dentist about the radiographs you might need throughout your treatment and the cost of dental X-rays. This will help you understand how dental insurance works and plan accordingly.

Coverage of dental X-rays under dental insurance

One of the key factors that decide whether your dental X-ray cost is covered is the purpose behind getting the X-ray done and what exactly your policy entails.

Basic vs. comprehensive dental insurance plans

Basic plans cover routine dental care, such as checkups, routine X-rays, and cleanings (for gum disease). Some insurance plans also cover pit and fissure sealants and fluoride treatments as preventive therapy. Dental insurance can cover a high percentage of the cost of dental X-rays, often 100%.

Comprehensive dental care includes extensive therapies like root canal treatments, crowns, bridges, dental implants, and dental prosthetics. Orthodontic treatment also falls under this category. Most dental insurance plans cover a lower percentage of comprehensive dental treatments, commonly 50–80% of the total cost of the X-ray.

Preventive vs. diagnostic dental X-rays

Dental X-rays can be categorized depending on their purpose. Preventive dental X-rays are part of a routine checkup and help to monitor potential issues. For example, a routine bitewing X-ray every six months is typically part of preventive care. Preventive X-rays are often fully covered by dental insurance.

Diagnostic dental X-rays are performed when a dental problem is suspected based on clinical signs and symptoms. For example, a panoramic X-ray is performed to diagnose the root cause behind tooth pain, which falls under the diagnostic category.

Frequency of dental X-rays

The number of dental X-rays done also determines how much coverage your policy will provide.

A bitewing or periapical X-ray twice a year is usually covered under dental insurance. Some factors, including your age and dental history, can also determine your insurance coverage. Young children with a high risk of dental issues are eligible for more coverage.

If you have dental problems or ongoing treatments before you enroll for the insurance policy, the chances of getting them covered decrease.

When dental insurance might not cover dental X-rays

Here is a list of instances when dental insurance might not cover your dental X-ray.

• When you opt for an out-of-network dentist, your dental insurance might not cover the expenses at all or can provide a lower coverage than an in-network dentist.
• In case you get a dental X-ray done without a dentist’s advice or prescription, you might end up paying for it out of your pocket.
• If you have a major dental condition before you enroll for a policy, chances are that it might not come under the insurance, and if it does, only a part can be covered.
• If your insurance policy has a waiting period, you might have to pay on your own for any treatments you go for before the period is over.
• If you have already exceeded your annual maximum limit, any new dental X-rays might not get covered by your insurance.

How the process of dental X-ray coverage works

It is best to verify coverage and plan your dental X-rays accordingly. Here is a three-step guide to increase your chances of getting your dental X-rays covered.

1. Choose your provider. Check the list of in-network healthcare providers from your policy. Opting for an in-network provider optimizes your chances of getting coverage. Contact the insurance website to get the details.
2. Get a recommendation. Some insurance policies require pre-approval or a recommendation from your dentist to cover X-rays. Your dentist will recommend your X-ray as a medical necessity to improve your chances of coverage.
3. Verify coverage to ensure you know your financial responsibilities. It will also help you understand any copayments, deductibles, or out-of-pocket payments you might incur.

Filing claims for X-ray reimbursement

Let's look at how to file a claim to cover your X-rays. Your dentist's office can often file the claim on your behalf, especially if they are an in-network provider. Knowing how to proceed to file a claim yourself is good.

• Collect all relevant documents, including approval letters, recommendation forms, and payment bills for the X-ray.
• Fill in the claims form from your insurance website. Ensure that you provide all necessary documents to support the claim.
• Submit the filled form and wait for further responses.

Dealing with denied claims

Your claim can get denied because of insufficient documentation, missing preauthorizations, or policy restrictions. If your claim is denied, you can appeal to reconsider the claim.

First, check why your claim was denied. Once you have identified the reasons, provide additional documents, approvals, or recommendations, as asked. Write a formal appeal letter or fill out an appeal form. Standard appeal forms should be available on the website, and if not, you can call customer service to have one sent to your home.

Get in touch with your policy provider to understand the exact proceedings.

How to maximize your dental insurance benefits for X-rays

Maximizing coverage needs planning your oral care and staying informed. Here are five things that can help you get the best out of your insurance plan.

1. Communicate with your dentist about insurance coverage. Dentists often know the insurance policies and can help you with what you need to consider before you take a policy.
2. Time your X-rays strategically. Most insurance plans have a frequency limit. Plan your X-rays within the frequency limit.
3. Review your insurance plan’s benefits. Know your plan thoroughly. Be sure of any copays, deductibles, and annual limits that you are entitled to.
4. Estimate the cost of dental X-rays before getting them done. Sit down with your dentist and understand the entire treatment plan. Discuss everything, from the X-rays to the final steps.
5. Make full use of your annual limits. In case you are yet to reach your maximum limit for a year, plan your X-ray to compensate for the amount and maximize your benefits.

Choosing an appropriate dental policy and understanding the clauses are crucial to covering the cost of X-rays. Besides that, the type and purpose of your dental X-ray also determine how much coverage you get out of your policy. Talk to your dentist and insurance provider to clarify how to time and plan your dental radiographs to maximize coverage.