Dental insurance calculator: what the plan pays on a treatment, and what is left to you
Type the price on your treatment plan and the terms of your coverage: the split between the plan and you updates as you go.
Your share of the bill
$515
The plan pays $465.
| Deductible | $50 |
| Your coinsurance | $465 |
| Plan share lost to the maximum | $0 |
Ask the office for a predetermination: the plan states its own allowed amount and share before treatment.
Compiled by Radif Partners · How prices are estimated · state Medicaid fee schedules, ADA ratios of 2024, BLS dental price index · not a quote
A dental plan pays in three steps, in this order. It first takes the deductible off the price it allows, $50 a year in the Covered California 2026 example plan used as the default here. It then pays its percentage for the class of the work: in that plan 80 % of basic services such as fillings and 50 % of major services such as crowns, root canals and dentures. Finally it stops at the yearly maximum still available, $1,500 in the example. On the median network price of a porcelain crown in the states priced here, $981, those steps give a plan payment of $466 and leave $516 to the patient. On a treatment of $6,000, the maximum binds: the plan pays $1,500 and the rest is yours. Out of network, the dentist can also bill the gap between the full fee and what the plan allows. The calculator applies each step to your own figures.
The three numbers the calculator needs
Every dental benefit summary carries the same few terms, sometimes under different names. The deductible is the amount you pay each plan year before the plan starts sharing costs; many plans waive it for checkups and cleanings. The coinsurance, or plan percentage, is the share the plan pays once the deductible is met, and it depends on the class of the work. The annual maximum, also called the yearly benefit limit, is the most the plan pays in a plan year; once reached, everything else is yours until the year renews.
The calculator also asks for the benefit maximum still left, because a plan that already paid for two fillings in March has less room for a crown in October. If you do not know how much you have used, the plan's member statement or the explanation of benefits from your last visit gives it. The price to type is the one on the dentist's written treatment plan, ideally the network amount the plan allows rather than the office's full fee.
A crown and a filling with the example plan
Take the median network price of a crown in the states this site prices, $981, with the default plan. The $50 deductible comes off first, the plan pays 50 % of what remains, and the result is under the maximum: $466 from the plan, $516 from you. A two-surface filling at its median network price of $158 is basic work at 80 %: the plan pays $87 if the deductible is still open, or $127 once it has been met earlier in the year.
| Case | Price allowed | Plan pays | You pay |
|---|---|---|---|
| Crown, network, deductible open | $981 | $466 | $516 |
| Filling, network, deductible open | $158 | $87 | $72 |
| Filling, network, deductible met | $158 | $127 | $32 |
| Crown, network, $750 of the maximum already used | $981 | $491 | $491 |
The last line shows why the order of treatments in a year matters. With $750 of the maximum already spent, only $750 remains, so the same crown can leave you a larger share than it would at the start of the plan year.
Try your own quote
Your share of the bill
$515
| Deductible | $50 |
| Your coinsurance | $465 |
| Plan share lost to the maximum | $0 |
When the maximum decides the bill
A yearly maximum turns a percentage into a ceiling. On a treatment of $6,000 in network, half after the deductible would be $2,975, but the plan stops at $1,500, so you pay $4,500, far more than half. Implants, several crowns or a full set of dentures often reach that ceiling in one plan year. The annual maximum page shows how splitting the work over two plan years changes the result, when the dentist agrees it can wait.
In network and out of network
A network dentist has agreed to accept the plan's allowed amount as the full price, so you never owe more than your share of it. An office outside the network can bill its full fee; the plan still pays only its share of its own allowance, and you owe the rest. The example plan also pays smaller shares out of network: it leaves you 10 % of preventive care instead of nothing, 30 % of basic work instead of 20 %. On a crown at the median full fee of $1,713, going out of network leaves you $1,247, of which $732 is the gap above the allowed amount. The crown cost page gives the state ranges of both prices.
The waiting period and the predetermination
New members often wait before major services are covered: 6 months in the example plan, waived with proof of earlier coverage. During that time the plan pays nothing for the class, whatever the percentage says. The calculator has a field for it under "More options", and the waiting period page works through the dates.
No calculator replaces the plan's own answer. Before a large treatment, the dental office can send the plan a predetermination, a request for a written estimate of what it will pay for the planned codes. It states the allowed amount, the class, the share and any limit such as frequency rules or an exclusion for a tooth missing before coverage began. Comparing that answer with the calculator shows at once which term differs from what you expected.
What the calculator does not decide
It sorts nothing into classes by itself: you choose the percentage from your benefit summary, because plans classify the same procedure differently. It does not check frequency limits, such as how often the same tooth can receive a new crown, nor the plan's rules on alternate treatments. And it says nothing about which treatment you need, which is for your dentist to judge. For prices without any plan, the page on paying without insurance sets out the full fees.