The question of whether insurance covers “teeth shaving,” professionally known as dental contouring or enameloplasty, is a common financial concern. Dental insurance is typically designed to cover services that treat disease or injury, rather than those purely for appearance. Coverage depends entirely on how the procedure is classified by the dental provider and the insurance company.
Understanding Dental Contouring and Enameloplasty
Dental contouring, or enameloplasty, is a minimally invasive technique used to reshape a tooth’s structure by removing a small amount of the outer enamel layer. This process is often performed using fine sanding discs, specialized rotary instruments, or dental lasers. The procedure is generally quick, often taking less than 30 minutes, and is painless because enamel has no nerves. The goal is to correct minor imperfections in the tooth’s shape, length, or surface texture, such as smoothing rough edges or correcting minor chips. Since the removed enamel does not regenerate, the procedure is considered permanent.
The Critical Difference Between Cosmetic and Necessary Procedures
Insurance coverage for enameloplasty is determined by distinguishing between a cosmetic procedure and a medically necessary one. Cosmetic contouring is performed solely to improve the aesthetic appearance of the smile. Standard dental insurance plans universally exclude coverage for procedures deemed purely cosmetic.
A procedure becomes medically necessary, and thus potentially covered, when it corrects a functional issue or prevents future harm. This includes removing a sharp or jagged edge that causes trauma to soft tissues like the tongue or cheek. Contouring may also be necessary to adjust a minor malocclusion (improper bite) that interferes with chewing or to prepare a tooth surface for restorative work, such as placing a crown or veneer.
Navigating Dental Insurance Coverage for Contouring
When dental contouring is performed for purely aesthetic reasons, standard dental plans will deny the claim. Dentists typically submit this cosmetic procedure using a Current Dental Terminology (CDT) code like D9971. Since this code is classified as an adjunctive general service and not a restorative one, coverage is rare unless the plan specifically allows for cosmetic benefits.
If the procedure is deemed medically necessary, it may be covered under the insurance plan’s basic or restorative benefits, often at a percentage ranging from 50% to 80%. To justify medical necessity, the dentist must provide thorough documentation, including clinical notes and sometimes X-rays, that clearly justifies the procedure’s function, such as alleviating soft tissue trauma or correcting a bite problem. The most effective strategy involves the dental office submitting a pre-authorization request, which secures a written commitment from the insurer regarding coverage before the procedure is performed.
Strategies for Managing Out-of-Pocket Costs
If insurance coverage is denied or limited, several financial options exist to manage the out-of-pocket costs. Patients may use tax-advantaged funds from a Flexible Spending Account (FSA) or Health Savings Account (HSA) for the expense. While these accounts generally exclude purely cosmetic treatments, they can often be used for dental contouring if the procedure is documented as medically necessary or restorative.
For costs not covered by insurance or tax-advantaged accounts, many dental offices offer flexible, in-house payment plans that allow the patient to pay the fee over several months. Alternatively, specialized healthcare credit cards are available that offer deferred interest or low-interest financing for medical and dental procedures. For those with limited coverage, a dental discount plan can provide a percentage reduction on the service fee in exchange for an annual membership.