The 100/80/50 Structure
Most dental plans use a 100/80/50 cost-sharing structure: 100% coverage for preventive services (cleanings, exams, X-rays), 80% for basic services (fillings, extractions), and 50% for major services (crowns, bridges, dentures). This structure incentivizes preventive care — which reduces the need for more expensive restorative care.
| Service Category | Typical Coverage | Examples |
|---|---|---|
| Preventive | 100% (no deductible) | Cleanings, exams, X-rays, fluoride |
| Basic | 80% after deductible | Fillings, simple extractions, root canals |
| Major | 50% after deductible | Crowns, bridges, dentures, implants |
| Orthodontia | 50% up to lifetime max | Braces, aligners (often children only) |
Annual Maximum and Deductible
Dental plans typically have an annual maximum — the most the plan will pay per person per year. Common annual maximums range from $1,000 to $2,500. Plans also typically have a deductible of $50–$100 per person that applies to basic and major services.
Dental Plan Design Optimization
Pro Tip
The most cost-effective dental plan design maximizes preventive care coverage (100% with no deductible) while managing major service costs through the annual maximum. Employees who use their preventive benefits regularly have lower major service costs — making the plan more sustainable. Consider increasing the annual maximum to $2,000–$2,500 to improve employee satisfaction without dramatically increasing plan cost.