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If you have ever read a dental plan summary, you have seen some version of “100/80/50.” It is the most common way US dental plans describe what they pay, and it is also one of the most misunderstood. Those three numbers are coverage percentages for three classes of care, and they determine how much of every dental bill lands on you.
What each class covers
Preventive care is covered at 100 percent. This includes exams, cleanings (usually twice a year), and routine X-rays. Most plans pay for preventive care with no deductible, which is why two cleanings a year often cost you nothing out of pocket.
Basic restorative care is covered at roughly 70 to 80 percent. This class includes fillings, simple extractions, and sometimes root canals, depending on the plan. You pay the remaining 20 to 30 percent after your deductible is met.
Major restorative care is covered at 50 percent. This is where crowns, bridges, dentures, implants, and complex oral surgery usually land. You pay the other half, after the deductible, up to your annual maximum.
How the math works on a real bill
Take a crown with a plan-allowed fee of $1,200. Crowns are major work, so the plan pays 50 percent after your $50 deductible: it covers $575, and you pay $625. Now take a composite filling with an allowed fee of $250. Fillings are basic care at 80 percent, so after the same $50 deductible the plan pays $160 and you pay $90. Preventive care skips the deductible entirely.
These are the standard class splits, but the exact percentages vary by carrier. Some plans cover basic care at 70 percent instead of 80, and some push root canals into the major category. Always check how your specific plan classifies the procedure you need before you book.
The two limits that matter as much as the percentages
The first is the annual deductible, usually $50 to $150 per person. Preventive care typically bypasses it, but basic and major work do not. The second is the annual maximum, commonly $1,000 to $2,500, which caps what the plan will pay in a benefit year. That maximum is why the 50 percent on major work rarely means what people think: on a $4,000 implant-and-crown case with a $1,500 maximum, the plan pays at most $1,500, and you cover the rest even though the “coverage level” is 50 percent.
Waiting periods also interact with these classes. Many plans cover preventive care immediately, impose 3 to 6 month waits for basic services, and 6 to 12 month waits for major work. See our guide to dental insurance waiting periods if you need care soon after enrolling.
What 100/80/50 does not tell you
The percentages say nothing about the plan’s allowed fees. A plan that covers 80 percent of a $150 allowed fee pays less than a plan covering 70 percent of a $250 allowed fee. The percentages also say nothing about exclusions: cosmetic work, teeth missing before the policy started, and replacements inside a waiting period can all be denied regardless of class. Our overview of what dental insurance actually covers walks through the common exclusions.
The bottom line
100/80/50 means full coverage for preventive care, most of the cost for basic repairs, and half for major work, all subject to your deductible and annual maximum. The percentages are a starting point, not the whole story. When the maximum runs out, which it does faster than most people expect, read what happens when you hit your dental annual maximum so you know your options for the rest of the year.
