Dental fillings and insurance
How plans usually pay fillings, why a back-tooth white filling is often paid at the silver rate, and how to quote the difference.
Fillings are basic services, often paid at 80% after the deductible. The common surprise is the downgrade.
The downgrade on back teeth
Many plans have an alternate benefit clause: when there is more than one way to treat a tooth, the plan pays the cheaper one. The ADA's example is a white (composite) filling on a back tooth, paid at the silver (amalgam) rate. The patient pays the difference.
| Step | Amount |
|---|---|
| White filling fee | $100 |
| Silver filling rate the plan pays at | $80 |
| Insurance at 80% of $80 | $64 |
| Patient pays | $36 |
The same arithmetic, deductible and yearly maximum included, is in how to calculate a dental patient portion.
Why filling claims come back short
- The downgrade above, which is a payment rule, not a denial.
- Replacing a filling too soon. Some plans limit how often the same surface on the same tooth is paid.
- The yearly maximum ran out earlier in the year. Check the maximum left, not the plan's total.
Before the visit
- Check the basic coverage percentage and the deductible left.
- Look for an alternate benefit or downgrade rule for back teeth.
- Quote the patient the downgraded amount. Tabruns applies it from your downgrade settings.
This is how plans usually work, not how every plan works. The patient's own plan documents and the insurer decide what's paid.
Codes you'll see
CDT is a registered trademark of the American Dental Association. Tabruns is not affiliated with or endorsed by the ADA. The descriptions here are our own plain-English summaries, not the ADA's official wording; use your current CDT manual or practice software for the official code set.
Terms on this page
Sources
Read November 11, 2026. Where a source describes one insurer's plans, we say so.
Get the patient's share in dollars, from the benefits page
Knowing how plans pay for fillings is half the job. Tabruns reads the coverage, deductible, yearly maximum, waiting periods and frequency limits from the insurer's portal and works out what the patient owes. Patient details stay on the office computer.
Not ready? Try the free patient portion calculator.