The cost of filling a cavity is always lower with dental insurance compared to paying 100% out-of-pocket without coverage. But by how much?

You may be asking yourself this question if tooth decay is an ongoing problem.

Should you begin paying premiums into a plan with waiting periods, and hope the investment pays off later when you need additional work?

Or, should you roll the dice and take money from your emergency fund (if you have one) for this round of treatment, and hope that this is the last time caries strikes?

Compare the damages with and without insurance and decide for yourself.

Cavity Filling Cost Without Insurance

Patients bear one-hundred percent of the retail cost of filling a cavity when they are uninsured. These out-of-pocket expenses can add up quickly, particularly if you have other oral health needs.

The amount you might have to budget per tooth ranges from a low of $150 just for the one appointment, to $800 when you fold in diagnostics, sedation, and other related charges.

Financial assistance programs can lower fees for select uninsured patients with the capacity to pay for future services. Learn how to prepare.

Delays

Delays in seeking treatment when you have tooth decay (caries) are the silent killer boosting all oral care costs. Without insurance to cover the charges, patients tend to procrastinate or attempt risky and unproven at-home remedies such as super glue.

By the time you reach the dentist’s chair, what could have been a simple filling of a small cavity could blossom into something much bigger and more expensive to treat.

  1. Abscess: a pocket of puss due to an infection
  2. Root canal: removal of infected tissue from the pulp chamber
  3. Extraction: pulling out a dead or cracked tooth
  4. Denture: replacement tooth to fill in the gap in your smile
  5. Periodontal disease: inflammation and bleeding of gums

Financing

Financing charges can increase the cost of filling a cavity when you do not have dental insurance. Many patients do not have enough money set aside in an emergency fund to cover surprise expenses and must borrow money to pay for treatment.

Types of Fillings

The retail price that a patient must fund without insurance to fill a cavity in a single tooth depends on three factors: the material used, the position in your mouth, and the number of surfaces treated.

The chart below depicts the average rates for the most common procedures. The amount a person might pay out-of-pocket can vary by region.[1]

Surfaces123+
Amalgam$150$200$250 +
Resin Front$225$280$340 +
Resin Back$235$300$360 +

Material

Your dentist can choose between five different materials when restoring tooth decay.[2] Each option has different pros and cons and price points, which your provider should discuss with you in advance.

  1. Amalgam is a mixture of several metals with a silver color used on chewing surfaces on posterior teeth
  2. Composite fillings mix resin with powdered silica and porcelain to form a tooth-colored packing
  3. Glass ionomer forms a chemical link with the enamel and is suitable for non-biting surfaces
  4. Gold inlays and onlays cover severely decayed areas with long-lasting performance
  5. Porcelain inlays perform the same function but with a tooth-colored material that is more aesthetically pleasing

Position

The position of the teeth in your mouth has a minor impact on the cost of treating caries without insurance. However, most dentists will match their material recommendations based on position.

  1. Anterior: incisors and canine teeth in the front of your mouth receive resin (white) materials for cosmetic reasons
  2. Posterior: bicuspids and molars in the back of your mouth receive amalgam (silver) materials for durability when chewing

Surfaces

The number of surfaces that your dentist must treat plays the most prominent role in the price you pay to treat caries. In general, the more surfaces in need of repair, the higher the charge will be. Each tooth has five areas that might need drilling and restoration.[3]

  1. Distal: towards the back of the mouth
  2. Occlusal: chewing or grinding area of bicuspid or molar
  3. Buccal: next to the cheek
  4. Mesial: forward or front
  5. Lingual: next to the tongue

Other Fees

Do not forget to figure in the related charges associated with filling a cavity. You may need to schedule more than one appointment, and your anxiety level could affect what you spend.

First, your dentist has to diagnose and size the scope of the problem before recommending treatment.

  1. Exam: $100
  2. X-rays: $200

Second, many patients fear the sound, grinding, and dust associated with a dental drill and need medication to relax them during the procedure. The local anesthetic (Novocain) is not enough; they need sedation, which increases the price tag further.

  1. Inhalation (Nitrous Oxide or Laughing Gas): $100
  2. Oral (Halcion or Valium): $100

Cavity Filling Cost With Insurance

The cost of filling a decayed tooth after dental insurance handles the claim depends on timing, the patient’s choice of dentist, the plan design, and the procedure billed to the plan.

  1. Materials used: amalgam or composite
  2. Position in the mouth: anterior or posterior
  3. Surfaces treated: from one to five
  4. Other services: exam, X-rays, pain management

In other words, every member will have a different amount of left-over expenses they must fund themselves. Follow along as we break down each factor related to the coverage you may already have or plan to purchase.

Network Savings

Potential discounts from participating providers in PPO plans are the most overlooked factor impacting the cost of filling a cavity with insurance. Your plan determines the total paid to any dentist (Allowed Charge), which varies based on the material, position of the tooth, and the number of surfaces restored.

Therefore, the amount you pay could vary based on whether the dentist you choose participates as an in-network provider, or not. For example, it might cost at least an extra $50 to use an out-of-network dentist because you lose the discounted rate.

ServiceAmount SubmittedAllowed ChargeDiscount
Amalgam: One Surface$150$100$50

Deductible

Your annual deductible is the second critical element determining how much it will cost to fill a cavity with insurance. The yearly deductible is the sum of allowed charges the member must fund 100% before the plan begins honoring claims.

Expanding on the simple example from above, a plan with a $50 deductible would work as follows.

Applied to DeductibleSub-Total
In-Network$50$50
Out-of-Network$50$100

Copayment

The copayment is the third crucial input that goes into calculating the unreimbursed costs with insurance to fill a decayed tooth. The copayment is typically a percentage of the allowed charges set under your plan.

Continuing with the same example from above, a plan with a 20% copayment for restorative services would work as follows.

CopaymentTotal
In-Network$10$60
Out-of-Network$10$110

Waiting Periods

The waiting period is a critical cost consideration for individuals who want to buy a new plan before having their cavity filled. A waiting period is the time during which a new member will not receive benefits for a particular class of treatments.

Fortunately, the waiting periods for fillings and other basic restorative procedures are short: 3 months is typical. If you can hold off for that long, making a purchase could prove worthwhile.

For people in a great deal of pain, investing in a plan right now could make sense – despite the waiting period.

  • An in-network dentist might have to honor the lower allowed charges even though the plan makes no claim payments
  • You could have needs for future dental work that would be covered after the specified number of months for each service
  • Plans without waiting periods have graded benefits (lower reimbursement levels) during the early years as a member

Footnoted Sources:

[1] Health Cost Helper Fillings

[2] Oral Health Foundation Filling Materials

[3] Patient Connect: Procedure Code Descriptions