What Is Not Covered Under Dental Insurance?
By Dr. Eastwood – Summerbrook Dental & Implants, Fort Worth, TX
Patients often ask me, “What is not covered under dental insurance?” While dental insurance can help reduce the cost of many treatments, it does not cover everything. Understanding what your plan won’t pay for can help you avoid surprises and plan your care with confidence. At Summerbrook Dental & Implants, my team reviews your benefits with you so you always know what to expect before treatment begins.
One of the biggest things not covered by many dental plans is dental implants. Even though implants are one of the best long-term solutions for missing teeth, many insurance companies consider them “elective.” Some plans may help with parts of the treatment—like extractions or dentures—but they may not cover the implant itself. Coverage varies, so we always check your plan carefully.
Another service often not covered is cosmetic dentistry. Treatments like teeth whitening, cosmetic bonding, veneers, or smile makeovers are typically considered “not medically necessary,” even though they can greatly improve confidence and quality of life. If a treatment is done only to improve appearance and not health, most insurance plans do not include it.
Many plans also do not cover orthodontics for adults. Some policies only pay for braces or clear aligners up to a certain age. If you’re an adult seeking orthodontic treatment, your plan may not provide benefits, or it may include only a small allowance.
Another common exclusion is major procedures needed because of accidents or injuries. Some dental plans won’t pay for trauma-related care and instead expect medical insurance to step in. This can include jaw fractures, knocked-out teeth, or facial injuries.
Sedation dentistry—such as oral sedation, IV sedation, or general anesthesia—may also not be fully covered. Even though sedation helps many patients feel safe and comfortable during treatment, insurance companies often consider it optional unless it is medically required.
At my office, we never judge patients for what their insurance does or doesn’t cover. My team works with you to find solutions that fit your goals and budget, whether you need basic care or advanced treatment like implants, bone grafting, or full-mouth restoration.
So, dental insurance often does not cover implants, cosmetic procedures, adult orthodontics, certain trauma treatments, or sedation. Knowing these limits helps you plan your dental care wisely and avoid unexpected costs.