On average, delta dental will cover dental bridges at 50% which means you’ll be responsible for paying half of it. The estimated average cost of a three unit bridge with delta dental is $1200 if you have 50% coverage. Although if you’re getting a longer span bridge, it would of course cost more.
However, there are other factors which can affect your overall coverage. These factors are frequency limitations, a missing tooth clause, and the annual maximum benefit. Triggering any of these stipulations may exclude you from benefits or reduce the amount of it.
We will explain what all of that means but before we start, you need to understand the different tooth cap bridge components and the billing codes used for them.
Note: We’re just giving you ball park figures, if you wanted to know how much it would cost you exactly, just ask your dentist to send out a pre-approval. You’ll receive a letter in the mail with a breakdown of the exact costs.
Dental codes for bridges
A dental bridge consists of two separate components, the abutments and the dental pontics. Each of these parts have a separate dental code for billing purposes. Although luckily for you, delta dental usually covers both of them at the same percentage.
Components of dental bridge and their billing codes:
- Abutment (D6750) – the crown that covers over an actual tooth.
- Pontic (D6240) – the “dummy” crown that replaces a missing tooth.
Essentially all bridges consist of a combination of abutments and pontics in varying quantities. It can have as many abutments and as many pontics as necessary.
The diagram above shows three different types of bridges and how it can come in many units.
Delta dental coverage for bridges
On average, the coverage for a bridge with delta dental insurance is about 50% which means you’ll have a 50% copayment. In other words, you’ll be responsible for paying for half of the treatment cost while your insurance covers the other half.
Below is an example of a benefits breakdown from one of our patients. It shows 50% coverage which is what we see on average with delta plans.
However, that doesn’t mean that you can’t have more or less coverage for this treatment with delta. We have seen some of our patients with plans that do have higher coverage and also some with lower coverage as well.
It all comes down to the specific plan that you purchased and signed up for.
Higher coverage example
To prove our point, below is an example of one of our patients who has higher than average coverage. They have 70% coverage for a tooth bridge which is more than average.
Cost of bridges with delta dental
The average cost of a 3 unit bridge with delta dental is $1123.50 and that is if you have 50% coverage for fixed prosthodontic services. That amount includes the cost of two abutments and one pontic.
The table below will break down the copay for each of the three codes:
|ADA Code||Coverage||Estimated Copay|
|D6750 (Abutment #1)||50%||$400|
|D6750 (Abutment #2)||50%||$400|
Basically, if you add up the copays for all three pieces you get $1200 and that will be your estimated out of pocket expense. Although you may have astutely noticed that the copays for each abutment and pontic are all the same. Therefore, to find out the cost of a bridge with a different amount of abutments/pontics is an easy task.
How to calculate the cost of your bridge:
- Determine how many “units” is your prosthesis. The total units is the sum of abutments plus pontics.
- Multiply the units by $400 and you will have your estimated copay.
Other factors affecting coverage
Even though your plan with delta dental may say that you have coverage for a bridge, there are factors which may exclude you from benefits or even reduce it.
- Missing tooth clause. Were you missing the tooth before getting the insurance?
- Frequency limitation. Have you had the procedure done before?
- Annual maximum. How much benefits do you have per year?
- Provider network status. Is your dentist in network or out of network?
Missing tooth clause
There is a stipulation in some plans called the missing tooth clause which can deny you bridge benefits if you were missing that tooth prior to getting your insurance. That means if you purchase the insurance in hopes of replacing your already missing tooth, you’ll be out of luck.
If you have the missing tooth clause, you can still get benefits for a bridge IF you get a tooth extracted while you’re on the insurance. Any other situation will preclude you from benefits.
Like other insurances, delta dental typically has a 5 year frequency limitation for bridge benefits. That means if you’ve had it done within the last 5 years, you may not have coverage for it.
Below is an example of a frequency limitation for this procedure. Delta highlighted the link in GREEN, “limitations apply.” We’ve circled and underlined the part where it says so.
What this means is that you can only get this treatment once every 5 years. If something happens to it within that time frame and you need to replace it, there would be no coverage.
Potential complications requiring replacement:
- Entire prosthesis fractures.
- Chipped porcelain.
- It falls out.
Despite delta dental potentially covering 50% of the treatment cost, you do have to take your annual maximum benefit into consideration. Most plans have $1500-$2000 of dental benefits per calendar year. If you use all of it, you will not get any more help from your insurance.
If the average cost of the bridge is $1200 that actually puts you really close to maxing out your annual benefits if you only have a $1500 max. In fact, you may have even exceeded it if you had a dental check up, cleaning, and annual x-rays done.
If you max out your insurance, you will be responsible for the remaining difference.
Provider network status
Everything that we’ve talked about thus far only applies to seeing a dentist that is in network with delta dental. These numbers are based on the contracted rate for a participating provider.
If you see an out of network dentist, one who is not contracted with delta, then NONE of what we’ve said applies. You could very well end up paying much more than $1200 for your treatment.
Yes, delta dental insurance can cover dental bridges and they usually give you 50% coverage. Although it can be higher if you purchased a more premium plan.
- The average coverage is 50% with a 50% copay.
- The estimated average cost is $1200 with 50% coverage for a 3 unit bridge.
- Call your insurance to check if there is a missing tooth clause.
- There is a 5 year frequency limitation on implant services.
- Make sure you see an in network dentist!
As long as you fulfill all of the conditions above, you will get your insurance benefit to replace your missing tooth. Restoring the lost tooth will provide you with additional chewing power.