What's the difference between in-network and out-of-network dental insurance?

In-network means we have a contracted rate with your insurance company — you typically pay lower out-of-pocket costs. Out-of-network means we don't have that contract, but most PPO plans still cover the same percentage of treatment. We accept both, and we'll show you the difference in writing before any work begins.

What does most dental insurance typically cover?

Most PPO plans follow a 100/80/50 split: preventive care like cleanings, exams, and X-rays is 100% covered, basic procedures like fillings and simple extractions are about 80% covered, and major work like crowns, root canals, and implants is around 50% covered. Plans vary, so we verify your specific benefits before your visit.

What is an annual maximum on a dental plan and why does it matter?

Most dental plans cap how much they'll pay per calendar year — usually between $1,000 and $2,500. Once you hit that ceiling, you're responsible for the rest until January 1 resets it. For larger treatments, we sometimes split procedures across two calendar years to maximize your benefits.

Do I have to pay my dental deductible upfront?

You'll pay your deductible (usually $25 to $100) at your first appointment that involves non-preventive work like fillings, crowns, or anything beyond a cleaning and exam. Most preventive care doesn't apply toward the deductible, so it can be free even before you've met it.

My spouse and I both have dental insurance — can I use both plans?

Yes — this is called dual coverage. Your primary plan pays first, then your secondary plan can cover most or all of the remaining balance. Bring both insurance cards to your visit and we'll coordinate benefits so you get the maximum coverage from both plans.

Can I use my HSA or FSA at your dental office?

Yes — dental care is a qualified medical expense, so you can use your Health Savings Account (HSA) or Flexible Spending Account (FSA) for any procedure, including cosmetic work, orthodontics, and your portion of insured treatments.

My employer offers multiple dental plans — which should I pick?

For most Bay Area patients, a PPO plan is the best choice — it gives you flexibility to choose any dentist and typically covers our practice. Avoid DMO and HMO plans if you want to come to us, as those often restrict you to a small assigned network.

What happens if my dental insurance denies a claim?

Our billing team handles it. We will appeal the denial on your behalf, submit additional documentation, and follow up with your insurer until it's resolved. If a claim ends up legitimately uncovered, we'll let you know exactly what you owe and can offer financing if needed.

Insurance and payment

Insurance and payment, simplified

We work with most major dental plans across the Bay Area and handle the paperwork so you do not have to. We check your coverage before you come in and tell you what treatment will cost before it starts.

Most major dental plans accepted
Free benefits check before your first visit
We file claims directly with your insurer
Out of network options available

Accepted insurance

We work with most major plans

These are the dental plans Bay Area families bring us most often. If yours is not listed, we can still see you, and we will tell you what your plan covers here before you book anything.

Plans we are in network with

Aetna
Cigna
MetLife
Guardian
United Healthcare
Anthem Blue Cross
Principal

Networks change from time to time. Call your local office to confirm before your appointment and we will check it while you are on the phone.

Do not see your plan? Call any of the three offices with your plan details and we will run a free benefits check, so you know what is covered before you come in rather than after. Find your office.

How it works

From plan card to claim, we handle it

What happens with your coverage from the moment you call to the day the claim is paid.

Step one Before your visit

Free benefits check

We contact your plan to verify coverage, your deductible and what is left of your annual benefit, before your first appointment rather than after it.

Step two At your appointment

A written cost breakdown

You see what your plan is expected to cover and what you owe before any treatment begins, with time to think about it.

Step three After your visit

We file your claim

The front desk submits it electronically. You do not fill in a form, print anything or post anything.

Step four If something is wrong

We take it up with them

If a claim comes back denied or underpaid, our billing team appeals it and follows it up, and tells you where it stands rather than leaving you to chase it.

Insurance questions

Common questions about dental insurance

Coverage is confusing by design. These are the questions patients ask us most. If yours is not here, call your local office and we will work through it with you.

What is the difference between in network and out of network?

In network means we have a contracted rate with your insurance company, which usually means lower out of pocket cost for you. Out of network means we do not have that contract, and your plan decides what it will pay.

We see patients on both. What we will not do is guess at your plan: we check it before you book and show you the difference in writing before any work begins.

What does dental insurance usually cover?

Most plans sort treatment into three tiers and cover each at a different rate. Preventive is cleanings, exams and X rays, and is usually covered at the highest rate. Basic is fillings and simple extractions. Major is crowns, root canals and implants, and is usually covered at the lowest rate.

The actual percentages are set by your plan and vary a lot between employers, so rather than quote numbers that might not be yours, we read your plan and tell you what it says.

What is an annual maximum and why does it matter?

Most dental plans cap what they will pay in a benefit year, commonly somewhere between $1,000 and $2,500. Once you reach that ceiling, the rest is yours until the year resets.

Where a large treatment can clinically be done in stages, we will tell you if one of those stages falls after your benefit year resets. The clinical plan comes first; the timing is just something worth knowing.

Do I have to pay my deductible upfront?

Your deductible is due at the first appointment that involves non preventive work. It is typically a small amount, a few tens of dollars, but your plan sets it.

Many plans do not apply the deductible to preventive care, so a cleaning and exam may cost you nothing before you have met it. That is not universal, which is why we check your plan first rather than telling you it is free and finding out otherwise.

My spouse and I both have insurance. Can I use both?

Usually yes. This is called dual coverage. Your primary plan pays first and your secondary plan may pick up some of what is left, depending on how the two coordinate.

Bring both cards and we will coordinate benefits between them so you get whatever the two plans together allow.

Can I use my HSA or FSA here?

Yes, for dental treatment. The IRS treats spending on the prevention and alleviation of dental disease as a qualified medical expense, which covers cleanings, exams, fillings, crowns, root canals, extractions, dentures and orthodontics. Use your HSA or FSA card at the desk.

Purely cosmetic treatment is the exception. The IRS lists teeth whitening by name as not qualifying, and excludes procedures aimed only at appearance. If you are unsure where a specific treatment falls, ask your plan administrator. We can tell you what the treatment is; only they can rule on your account.

What if treatment costs more than my plan covers?

You will know before it happens, not after. The written cost breakdown shows what your plan is expected to pay and what is left for you, before treatment starts.

For the remainder there is third party financing you can apply for through the office, payment arrangements we can set up for larger treatments, and HSA and FSA funds if you have them.

What if my insurance denies a claim?

Our billing team takes it up. We appeal the denial, send whatever additional documentation the insurer asks for, follow it up, and tell you where it stands rather than leaving you to chase it.

If a claim genuinely is not covered, we will tell you exactly what you owe and what your options are for paying it.

What if I do not have insurance at all?

Plenty of our patients do not. Our in-house membership plan covers your preventive visits for a flat annual fee and brings member pricing to everything else, with no deductible, no claim forms and no annual maximum. Call for pricing.

For larger treatment there is also third party financing you can apply for through the office.