A dental plan that covers implants commonly pays 50% of the covered charge under its major restorative benefit, after your deductible. The plan's annual maximum then caps the total payout. According to the American Dental Association, common maximums are $1,000 or $1,500, so any Salt Lake City implant bill above that cap falls to you.
How do dental plans classify dental implants?
Many plans sort procedures into preventive, basic, and major tiers. The ADA describes a common plan design that pays 50% for major restorative services, and a plan that covers implants may place them in that tier.
Not every plan covers implants at all. Your benefits summary will say whether implants are covered, excluded, or limited. Look for these terms, because any of them can change what you owe:
- Deductible: the amount you pay before the 50% applies.
- Waiting periods: a set time after enrollment before major services are covered.
- Missing-tooth clause: a rule that can exclude teeth lost before your coverage began.
- Frequency limits: limits on how often a service is covered.
- Exclusions: services the plan will not pay for.
How much of the cost will a typical plan pay?
The 50% applies to your plan's covered or allowed charge after the deductible. It does not necessarily apply to the full amount the dental office bills.
The ADA also notes that a plan's stated percentage does not by itself determine what the insurer pays, because the annual maximum limits total reimbursement. The percentage is only the first half of the math.
How does the annual maximum limit what insurance pays?
Dental plans commonly set a yearly dollar limit on what they reimburse, even when your dental expenses are higher. The ADA lists $1,000 or $1,500 as common annual maximums and says plans with $2,000 or $3,000 maximums also exist.
The maximum may apply to one person or to a whole family, depending on the plan. If other family members use dental benefits in the same year, less remains for your implant.
Here is the arithmetic for a plan that pays 50% with no deductible remaining. This is an illustration, not a price estimate.
| Annual maximum | Covered charges at which 50% reaches the cap | Most the plan can pay |
|---|---|---|
| $1,000 | $2,000 | $1,000 |
| $1,500 | $3,000 | $1,500 |
| $2,000 | $4,000 | $2,000 |
| $3,000 | $6,000 | $3,000 |
Once covered charges pass the figure in the middle column, every additional dollar is yours. Your dentist's written treatment plan shows how far the total runs past that point. You can compare it with the ranges on our dental implant cost page.
Which CDT billing codes should you request on a pretreatment estimate?
CDT codes are the standard procedure codes dental offices use on claims. Ask the treating office for the complete list of codes it plans to bill, then give that list to your insurer so each line can be checked for coverage.
Two crown codes come from the ADA's CDT code materials:
| Code | Procedure |
|---|---|
| D6058 | Abutment-supported porcelain or ceramic crown |
| D6065 | Implant-supported porcelain or ceramic crown |
Which of these applies depends on how your crown attaches, and your dentist decides that after an exam and imaging. Ask which code the office expects to use.
An implant is more than a crown. The University of Utah School of Dentistry, for example, lists dental implants and bone grafting as separate dental-surgery services. Ask for the code for each step your plan includes, such as placing the implant or grafting, and ask your insurer whether each one is covered. A crown-only estimate can leave out the largest lines on your bill.
What is a pretreatment estimate, and what does it tell you?
The ADA defines predetermination of benefits as an administrative process that may require your dentist to submit a treatment plan before treatment begins. Some plans call it a pretreatment estimate or prior authorization.
The result is an estimate of your benefits, not a final payment decision. Your actual payment can still depend on your deductible, your remaining annual maximum, and your eligibility on the date of service.
Turnaround varies by insurer and by how the request is submitted. When your dentist's office sends the request, ask your plan how long it takes and how you will receive the result.
What should you do during fall open enrollment?
As of October 2026, fall is when many employers let you review or change benefits. Use that window to check your plan details before you schedule anything.
- Request the full benefits summary and look for implant coverage, exclusions, and waiting periods.
- Find your annual maximum and whether it is per person or per family.
- Note your deductible and the percentage for major restorative services.
- Ask whether a missing-tooth clause or frequency limit applies.
- Compare plans on those points, not only on the monthly premium.
If your plan pays little or nothing toward implants, a one-year maximum may still be worth planning around. Whether to time care across plan years is a question for your insurer and your dentist.
What if your insurance pays little toward implants?
You still have options to compare. The University of Utah says dental students and residents provide discounted care under supervision when patients pay out of pocket. Its Salt Lake City dental school is at 530 Wakara Way, Salt Lake City, Utah 84108. It also states that insurance plans and benefits vary by policy.
The university says it accepts Utah Medicaid at its locations and asks patients to confirm whether a particular office is currently accepting Medicaid patients. Ask what, if anything, your Medicaid benefit covers for implants before you plan around it.
Our pages on affordable dental implants and single-tooth implants in Salt Lake City explain more about planning for out-of-pocket costs. Our guide to choosing an implant dentist lists what to ask at a consultation.
Want help finding a local implant dentist? Call (385) 213-6277 or send a request and we will connect you with a licensed implant dentist in the Salt Lake City area. We are a free referral service, not a dental office, and the dentist you meet decides what fits your mouth after an exam and X-rays or a CT scan.
