If your family dentist has referred you to a periodontist for specialized treatment, now may be the time to invest in your oral health.
Comparing the costs of periodontal treatment with and without insurance for patients with gum disease makes excellent sense.
After an initial consultation and evaluation, your periodontist will recommend a treatment plan that will take place over time.
You might find that buying a new dental plan will make these services more affordable, even with the upfront monthly premiums.
Or you might decide to pay out-of-pocket and need to know what to budget and find ways to finance the procedures.
Periodontal Costs with Insurance
The cost of periodontal treatment with insurance can help you decide whether to purchase a plan. Patients with gum disease often find that the benefits outweigh the monthly premiums.
Medicaid covers periodontal care in nineteen states. Patients in the thirty-one other states should consider how four standard dental insurance features combine to determine their unreimbursed expenses.
Allowed Amount
The allowed amount is the most favorable feature in determining the periodontal treatment costs with PPO dental insurance. Periodontists who participate in-network agree to discount their fees significantly in exchange for more patient referrals.
In-network dentists must accept the contract amount stated in the EOB. Meanwhile, those not participating in the PPO arrangement set fees at market rates. It is not uncommon to realize savings of 50% or more.
Allowed Amount vs. Retail Price Per Quadrant
| Treatment | In-Network | Out-of-Network |
|---|---|---|
| Deep Cleaning | $225 | $450 |
| Periodontal Maintenance | $150 | $300 |
| Flap Surgery | $1,250 | $2,500 |
| LANAP Surgery | $2,000 | $4,000 |
| Gum Grafting | $600 | $1,200 |
| Pinhole Rejuvenation | $700 | $1,400 |
Annual Maximum
The annual benefit maximum often increases the cost of periodontal treatment with dental insurance. The yearly maximum limits the benefits the plan pays in twelve months.
When you max out your dental insurance, spread the claims out over two years or more. Your periodontist may treat one quadrant of your mouth at a time, allowing the process to spill over to a new plan year.
For instance, a plan with a $1,500 annual maximum will pay $1,500 towards the allowed amount if you condense treatment into one year and $3,000 if spread over two.
Co-payments
The co-payment is the final factor determining the cost of periodontal treatment with insurance. It is the percentage of the allowed amount you owe after your plan pays for covered services.
Even with dental insurance, you might have to pay upfront because your plan probably includes co-payments. Get a pre-treatment estimate from your insurance company to budget for this left-over expense.
Co-payment on Allowed Amount Per Quadrant
| Treatment | 20% Co-payment | 50% Co-payment |
|---|---|---|
| Deep Cleaning | $45 | $112 |
| Periodontal Maintenance | $30 | $75 |
| Flap Surgery | $250 | $625 |
| LANAP Surgery | $400 | $1,000 |
| Gum Grafting | $120 | $300 |
| Pinhole Rejuvenation | $140 | $350 |
Waiting Period
For patients purchasing a new plan, the waiting period is the most significant factor in the cost of periodontal treatment with dental insurance. A waiting period is when the program does not pay benefits.
Dental insurance with no waiting periods for periodontal treatment exists but does not save much money. The issuing companies seek profits and offer graded benefits that immediately begin while increasing over time.
| Year | % of Allowed Charges Paid |
|---|---|
| 1 | 25% |
| 2 | 30% |
| 3 | 50% |
Treatment Costs Without Insurance
Knowing how much periodontal treatment costs without insurance can help you decide whether to buy a plan. Patients with gum disease must cover these expenses out-of-pocket.
Gingivitis Costs
The cost of gingivitis treatment without insurance is much lower than later-stage services. As the saying goes, an ounce of prevention is worth a pound of cure.
Scaling and Planing
Your periodontist might recommend scaling and root planing (deep cleaning) to treat your gingivitis and prevent the gum disease from worsening.
During a deep cleaning, your dentist will remove the plaque and tartar from your teeth above and below your gum line.
Scaling and root planing without insurance costs $100 to $450 per quadrant but can range up to $4,000 for your entire mouth, depending on how deeply the periodontist must clean.
Periodontal Maintenance
Your provider may also recommend periodontal maintenance to treat your gingivitis after completing the deep cleaning. You might need maintenance services every three months to prevent disease-causing bacteria from recolonizing your gums.
The cost of periodontal maintenance without insurance ranges from $150 to $300 per treatment or $600 to $1,200 annually if performed four times a year as recommended.
Prescription Drugs
Your periodontist might also recommend prescription drugs you can take at home to treat your gingivitis and prevent the gum disease from worsening. In these cases, your costs without dental insurance might be irrelevant for two unique reasons.
Prescription Antibiotics
The cost of antibiotics without dental insurance may be irrelevant when prescribed by your periodontists because your healthcare plan might participate.
Medical insurance often covers antibiotics, meaning your out-of-pocket costs could be negligible if you submit a claim to your carrier. If not treated aggressively, oral infections can quickly spread throughout the body.
GUMX
The cost of GUMX Defender Plus+ without insurance might be irrelevant because you can get an equivalent at-home treatment over the counter without a prescription.
You can purchase the generic equivalent of GUMX online for a fraction of the price charged by your periodontist. For example, several companies sell a 1.7% hydrogen peroxide gel with trays, with prices starting at $25 for a 3.5-ounce tube.
Periodontitis Treatment
The costs without insurance are much higher for the more invasive surgical treatments for periodontitis, the more advanced form of gum disease.
Dental loans for low-income adults might help defray some of the cost of these more expensive procedures. You do not want to lose teeth by allowing periodontitis to progress further.
Flap Surgery
Your provider might recommend Gingival Flap (Osseous) surgery to treat periodontitis. During a flap procedure, the periodontist separates the gums from the teeth to scrape tartar and plaque from the roots and bone to reduce pockets.
Pockets are areas below the gum line where tissue has detached from the teeth. Harmful bacteria can proliferate in these difficult-to-clean spaces, so reducing them is critical.
The cost of osseous flap surgery without insurance ranges from $500 to $10,000, depending on the number of quadrants treated and the extent of your gum disease.
LANAP Surgery
Laser gum surgery is the more modern approach to treating periodontitis. The FDA-approved Laser-Assisted New Attachment Procedure (LANAP®) offers a less invasive alternative to traditional procedures that use scalpels and sutures.
LANAP surgery costs without insurance range from $2,000 to $8,000, depending on the number of quadrants requiring treatment. Of course, you must shop around to find a periodontal office that has invested in laser equipment.
Receding Gums
The cost of treating receding gums without insurance depends on the surgical procedure recommended by your periodontist.
Gum Grafting
Your periodontist might recommend grafting surgery to treat your receding gum line. Gum grafting covers exposed tooth roots, reducing decay risks, sensitivity, and bone loss.
The cost of gum grafting without insurance ranges from $600 to $1,200 per tooth, meaning the procedure can be pretty expensive if you have recession throughout your mouth. Prices are even higher if you purchase tissue from a bank instead of harvesting it from elsewhere from your palate.
Pinhole Rejuvenation
Your periodontist could recommend Pinhole Rejuvenation surgery to treat your receding gum line. With this technique, the surgeon makes a small hole in the gingiva and uses special instruments to loosen the tissue and stretch it over the exposed tooth roots.
The cost of Pinhole Rejuvenation without insurance ranges from $600 to $1,400 per tooth, or about the same as a surgical graft, but without the need for cutting and sutures. As a newer technique, you must shop around for a periodontist experienced with this approach.
