Dental Insurance Cost Estimator

How to use the dental insurance cost estimator

1. Enter your plan. The percentage it pays for preventive, basic and major care, the deductible you have left and the annual maximum you have left. Your summary of benefits lists all of them. If you’re partway through the year, use what’s left, not the full amounts.
2. Tick any waiting period you’re still in. New plans often won’t pay for basic care for 6 months or major care for 12.
3. Add your procedures. Each one starts at the US average fee. Replace it with the fee on your dentist’s treatment plan if you have one.
4. Read the estimate. What the plan pays and what you pay, per procedure and in total. Open Show the working to check each step.

How dental plans split the cost

Most PPO plans, including many Delta Dental plans, sort procedures into three classes and pay a different share of each. The estimator starts with this typical 100/80/50 structure:

Plans differ. Some put root canals or deep cleaning under major care, some pay 70% or 60% for basic work, and some don’t cover implants at all. A common deductible is $50 per person a year, and common annual maximums are $1,000 to $2,000. Every number in the estimator can be changed to match yours.

How the estimate is calculated

Procedures are worked out in the order you list them, the way claims are processed through the year:

1. Waiting period. If the procedure’s class is still in a waiting period, the plan pays nothing and the deductible isn’t touched.
2. Amount the plan counts = the fee, or the silver-filling rate for a tooth-coloured filling on a back tooth, whichever is lower.
3. Deductible = the smaller of the deductible you have left and the amount counted. Skipped for preventive care unless you tick the box.
4. Plan share = (amount counted − deductible) × the class percentage, rounded to the cent.
5. Plan pays = the plan share, or what’s left of your annual maximum if that’s less.
6. You pay = the fee − what the plan pays.

Worked example: a checkup, a filling and a crown

Select Load an example to see this in the estimator. The plan is 100/80/50 with a $50 deductible and $1,500 of the annual maximum left.

• Checkup, $203. Preventive, so no deductible. 100% of $203: the plan pays $203.00 and you pay $0. Maximum left: $1,297.
• Silver filling, $139. Basic. The $50 deductible leaves $89, and 80% of $89 is $71.20. The plan pays $71.20 and you pay $67.80. Maximum left: $1,225.80.
• Porcelain crown, $1,399. Major, and the deductible has been met. 50% of $1,399 is $699.50. The plan pays $699.50 and you pay $699.50. Maximum left: $526.30.
• Total: $1,741 of treatment. The plan pays $973.70 and you pay $767.30.

Price a $2,143 implant followed by the same crown on its own, and the maximum runs out: the plan pays $1,046.50 toward the implant and only $453.50 toward the crown, $1,500 in all, and you pay $2,042.

Typical costs the estimator starts from

US national averages from the 2024 Synchrony Average Procedural Cost Study. Your dentist’s fees may be well above or below them, and in-network fees are usually lower.

Using it with a Delta Dental plan

Delta Dental has its own cost estimator. It shows what dentists near a ZIP code typically charge for one procedure. It doesn’t take off your deductible, apply your coverage percentage or your annual maximum, or add up a treatment plan. Its figures are what the dentist charges, not what you pay after insurance. Members can log in to see estimates based on their own plan.

This page does the next step. Take the fee, from Delta Dental’s estimator or your dentist’s treatment plan, and your plan’s percentages, deductible and maximum from your summary of benefits, and it works out both shares. It’s independent. It has no access to Delta Dental’s fee schedules or your claims, so it’s only as accurate as the numbers you put in.

Two Delta Dental rules are worth knowing. Many plans pay a back-tooth white filling at the silver-filling rate, and the estimator applies that to the tooth-coloured, back tooth option. Many also won’t pay to replace a tooth that was already missing before your coverage started.

What the estimate leaves out

• Frequency limits. Most plans pay for two cleanings a year and full-mouth X-rays every few years. Extra visits may not be covered.
• Out-of-network billing. An out-of-network dentist can bill you the difference between their fee and what the plan allows.
• Your plan’s own class list. If your plan counts a procedure as a different class, change that class’s percentage or use an Other row.
• Family deductibles and orthodontics, which have their own limits.

For major work, ask your dentist to send a pre-treatment estimate to your insurer. It’s free, and it’s the only figure your plan commits to.

Sources

• CareCredit: Dental procedure costs. US averages from the 2024 Synchrony Average Procedural Cost Study.
• Delta Dental: What does my dental insurance cover? The 100/80/50 structure, deductibles and maximums.
• Delta Dental: Tooth filling cost and coverage. Alternate benefit on back-tooth fillings.
• Delta Dental: Dental implant cost. Implant coverage and the missing tooth clause.
• Delta Dental: Cost estimator. The official tool, for what dentists near you charge.

Checked 17 September 2026. FreeToolBank isn’t a dentist or an insurer, isn’t affiliated with Delta Dental, and receives nothing from the sources above. Delta Dental is a trademark of its owner, used here only to describe what this page helps with.