Insurance

Being out-of-network simply means our office doesn’t have a direct contract with your insurance provider. However, we can still accept your insurance. For in-network carriers, services are billed at contracted rates. For out-of-network carriers, we use the standard service fee and apply the coverage percentage outlined in your out-of-network benefits to determine your portion. We accept most major PPO insurances but are not contracted with Denti-Cal, Medi-Cal, or HMO plans.

While dental insurance works similarly to medical and vision insurance, there are key differences. Like medical coverage, dental insurance usually comes through your employer, involves monthly premiums, and has specific rules about providers and benefits. However, dental insurance typically has an annual maximum reimbursement limit, while medical insurance covers expenses once you meet your out-of-pocket maximum.

Dental insurance functions much like medical insurance, but with one key difference: dental plans cover costs up to a set “maximum allowable” amount per benefit period (usually annually). After reaching that limit, you’re responsible for additional costs. Coverage is typically divided into categories — preventive, basic, and major — with common coverage levels of 100%, 80%, and 50%, respectively. These percentages vary by plan, so it’s important to review your individual benefits. Any amount not covered by insurance is the patient’s responsibility.

Most dental insurance plans cover preventive care (like exams and cleanings twice a year), basic treatments (such as fillings or crowns), and major procedures (like oral surgery or orthodontics). Coverage usually follows a tiered structure — for example, 100% for preventive, 80% for basic, and 50% for major services. Orthodontic coverage often includes additional conditions, such as age limits and lifetime maximums instead of annual limits.

PPO stands for “Preferred Provider Organization.” With PPO plans, you don’t need to select a primary dentist or get referrals to see specialists. However, you’ll typically save more when visiting in-network providers. This differs from HMO/DHMO plans, which require you to choose a primary dentist and limit you to their network, though they often offer lower costs and minimal copays.

Most PPO dental plans cover two routine exams and cleanings each calendar year.

In many cases, yes — though coverage varies. Some plans include exclusions like a “missing tooth clause,” which prevents coverage if the tooth was missing before your plan began. Our team can help you check your specific benefits and rules before starting treatment.

Usually, yes. Orthodontic coverage often comes with certain conditions — for instance, limits based on age, eligible family members, or total benefit amount. Unlike other treatments, orthodontics typically have a lifetime maximum rather than an annual limit. We can review your policy details to confirm what’s included in your plan.