The short version

On a typical plan, Dental insurance sorts covered care into three tiers and pays a different share of each: preventive care around 100%, basic care around 80%, and major care around 50%, after a deductible of roughly $50. Everything the plan pays counts against an annual maximum — usually $1,000 to $2,000 per person per year — and orthodontics is normally handled as a separate benefit with its own limit. The catch worth remembering is that what lands in each tier genuinely varies by plan, so the only way to know for certain is to read the plan’s Summary of Benefits. The Jordan Insurance Agency, an independent agency in Charlotte, North Carolina, compares plans across carriers so you can see exactly what a given plan covers before you enroll.

The framework: the 100/80/50 model

Almost every full and PPO Dental plan is built on a three-tier coinsurance structure, commonly described as “100/80/50.” After you meet any deductible, the plan pays a set percentage of the cost of a covered service, and you pay the rest. The percentages differ a little by plan, but the categories — preventive, basic, and major — are the backbone of nearly every plan you will see. Understanding what falls into each tier is most of understanding what a plan covers. If you want the bigger picture of how premiums, deductibles, and maximums fit together first, start with what Dental insurance is and how it works.

Preventive and diagnostic care — usually about 100%

This is the care the plan most wants you to use, and it is typically covered at around 100%. It generally includes routine cleanings, oral exams and checkups, and routine X-rays such as bitewings, and it often extends to fluoride treatments and sealants. Because the plan is trying to keep small problems small, preventive care is usually paid before you have met your deductible — so your twice-a-year cleaning is commonly covered in full from the very first month. Most plans cap preventive visits at about twice a year, roughly every six months.

Basic care — usually about 80%

Basic services are the common repairs a lot of people need at some point: fillings, simple (routine) tooth extractions, and gum-disease treatment such as scaling and root planing. On a typical plan the plan pays about 80% after the deductible and you pay the remaining 20%. Root canals most commonly sit in this basic tier as well, though some plans move them up to major — more on that below.

Major care — usually about 50%

Major services are the expensive, less-frequent procedures: crowns, inlays and onlays, bridges, dentures, dental implants, and oral surgery. These are typically covered at around 50% after the deductible, meaning you and the plan split the cost roughly evenly. Because major work carries the biggest price tags, it is also where the annual maximum matters most. If you are facing a crown, bridge, or denture, our guide to whether Dental insurance covers crowns and major work goes deeper.

Why the tiers are not set in stone

The single most useful thing to understand about coverage is that the tier a procedure lands in varies by plan. The classic example is the root canal: on most plans it is treated as a basic service and covered at a higher percentage, but on some plans it is treated as major and covered at a lower one. That one difference can change your out-of-pocket cost meaningfully. We cover it directly in does Dental insurance cover root canals. The takeaway is simple: never assume a procedure’s tier or percentage is universal — confirm it on the specific plan.

The deductible and how it applies

The deductible is the amount you pay out of pocket before the plan begins paying for basic and major care. For an individual it is often around $50 (roughly $150 for a family), and across the market it tends to range from about $25 to $100 depending on the plan. The nuance that saves people money: the deductible usually applies only to basic and major work. Preventive care is generally paid at around 100% before you have touched the deductible, which is why cleanings and exams are typically covered right away. Some plan types — particularly DHMO-style plans — skip the deductible entirely and use fixed copays instead.

The annual maximum — the ceiling on what the plan pays

Every dollar the plan pays out counts against your annual maximum, which is commonly $1,000 to $2,000 per person per benefit year. Once the plan has paid that much, it stops paying for the rest of the year and you cover 100% of any further costs, until the maximum resets. Two details matter here. First, only what the plan pays counts toward the maximum — your coinsurance share does not eat into it. Second, this ceiling has stayed roughly flat for decades rather than rising with inflation, so it can feel modest against the cost of major work today. A few plans now offer a rollover or carryover feature that lets unused benefit carry into the next year, but treat that as a feature of some plans, not the norm. To see how the maximum and deductible shape your monthly premium, see how much Dental insurance costs.

What a year of coverage can look like

It helps to see the tiers work together. Picture a plan with a $50 deductible, an annual maximum of $1,500, and standard 100/80/50 coverage. Your two cleanings and exams for the year are preventive, so they are typically covered at about 100% with no deductible — little or nothing out of pocket. Midyear you need a filling, a basic service: you first meet the $50 deductible, then the plan pays about 80% and you pay the remaining 20%. Later you need a crown, a major service: after the deductible the plan pays about 50% and you pay the other half, and whatever the plan pays comes off your $1,500 annual maximum. If a second major procedure that same year would push the plan’s total payout past $1,500, you would cover the overflow yourself until the maximum resets. Nothing here is a quote — the exact dollars depend entirely on your plan and your dentist’s fees — but the shape is what coverage looks like in practice.

Orthodontics is usually its own benefit

Braces and clear aligners are typically not paid out of the same bucket as the rest of your care. Orthodontics is usually a separate benefit with its own separate lifetime maximum — not the annual maximum — commonly paid at about 50% up to a lifetime limit that often falls somewhere around $1,000 to $3,000 over the life of the coverage. Orthodontic coverage is also frequently limited to children and teens (often under age 19), with adult orthodontics less commonly covered but available on some plans. If braces are on your radar, see does Dental insurance cover braces.

Two fine-print items that surprise people

A couple of common clauses catch people off guard, so it is worth naming them. A missing tooth clause means a plan may not cover a prosthetic — an implant, bridge, partial, or denture — that replaces a tooth that was already extracted before the policy’s effective date. In other words, a tooth you lost before the coverage began may not be covered when you later go to replace it. Separately, plans apply frequency limitations that cap how often they will pay for a service: preventive cleanings and exams are most commonly covered about twice a year, and things like replacement crowns or dentures carry their own limits (for example, a replacement only every so many years). Neither of these is a reason to avoid coverage — they are just reasons to read the plan closely, especially if you have existing missing teeth or dental work.

What Dental insurance tends not to cover well

Coverage is strongest for routine and restorative care and thinner for the big-ticket and the elective. Implants were historically excluded as “cosmetic” and, while they are increasingly covered today as a major service, coverage still varies heavily by plan — some plans cover the crown and related work but not always the implant post itself. Purely cosmetic procedures are commonly excluded. And the annual maximum means that even covered major work can leave a real out-of-pocket balance in a single year. If you want the richest option, our page on full-coverage Dental insurance explains what that term really means and what it does not.

How to read your own plan’s coverage

Every plan spells all of this out in a document usually called the Summary of Benefits (sometimes a schedule of benefits or an evidence of coverage). It is the single most useful thing to read before you enroll, and it is where you confirm four things: which services sit in the preventive, basic, and major tiers and at what percentages; the deductible and the annual maximum; any waiting periods by tier; and the exclusions and limitations, including any missing tooth clause and frequency limits. If a plan’s marketing says it “covers major work” but the schedule shows a low percentage, a long waiting period, and a modest annual maximum, you now know exactly what that phrase is worth. Reading it is not glamorous, but it is how you avoid the surprises — and it is precisely the part an independent agent can do with you.

What this looks like in North Carolina

None of this changes in a special way for North Carolina. The tiers, deductibles, annual maximums, and orthodontic limits described here are industry-wide and apply the same way in Charlotte as anywhere else. Stand-alone Dental plans sold to North Carolina consumers are regulated by the North Carolina Department of Insurance and are not subject to the ACA pediatric-dental essential-benefit rules that apply to medical plans. The practical implication is that coverage details are set by the plan you choose, not by a state-specific rulebook — which is exactly why comparing plans matters.

How The Jordan Insurance Agency helps

Reading a Summary of Benefits and matching it to the care you actually expect is the whole game, and it is where an independent agent earns their keep. Because Dental usually rides alongside a Health or Medicare conversation, The Jordan Insurance Agency looks at your situation as a whole and compares real North Carolina plans side by side — which tier your likely procedures fall in, what the deductible and annual maximum are, and where the waiting periods and clauses hide. This page is educational, not a guarantee that a particular plan covers a particular procedure; always confirm against the plan’s Summary of Benefits. When you want a second set of eyes, we will compare your options at no cost.