Dental implants and insurance
Whether plans usually pay for implants, the exclusions and missing tooth rules to check, and how the yearly maximum limits what's paid.
Delta Dental lists implants as major procedures, often paid at 50%. Implant coverage varies more than almost anything else: some plans pay for them, some pay only an alternate benefit, and some exclude them.
What decides the payment
- Exclusions. Look for implants under exclusions first. If they're excluded, the whole case is the patient's.
- An alternate benefit. Some plans pay what a bridge or denture would have cost and leave the rest to the patient.
- The missing tooth clause for a tooth lost before coverage began.
- The yearly maximum. At 50%, one implant and its crown can use a whole year's maximum. Some offices plan the steps across two plan years.
- A waiting period on major work.
Before the visit
- Check exclusions, alternate benefits and the missing tooth clause.
- Ask the extraction date if the tooth is already gone.
- Send a predetermination, and quote each step against the maximum left in its plan year.
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 implants 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.