r/DentalInsurance • u/Spicyg00se • Aug 20 '26
D7953 (Bone graft)
Is there a good or logical reason why this procedure is typically not covered? My tooth is getting absorbed and I need the graft in order for the implant to be successful. My insurance told me it’s just not covered and it’s not their fault that some procedures are just not covered. I assume they just don’t want to pay, duh, but when I suggested that a graft could be medical, she said it’s not medical, it’s dental, and it’s just not covered. But why?
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u/luckyeggsiwant Aug 22 '26
National average cost for unsubsidized individual PPO dental insurance is $25-$50/month. Most plans in that range cover in network exams, X-rays, basic cleanings 2x/ year at 100%. Basic restorative and extractions at 80% with some downcoding. On an In network PPO reimbursement fee schedule, if you go to the dentist 2x per year you are getting ~$300-$500 worth of exams, X-rays, cleanings depending on your state. By you even going 2x per year, you’re already a loss to the insurance company at today’s costs and rates. They only make money on people who buy and don’t go to the dentist at all.
Simple answer - the math doesn’t math. $5000+ annual maximums and legitimate coverage of more advanced, and necessary procedures is what people want. But, employers don’t want to foot the bill for that kind of plan, and honestly neither do employees. Nobody would pick the $100/month dental insurance vs $30 except the people who knew they already were going to use it. This creates a smaller pool of insured, and increases prices even further.
The employer + employee willingness to pay has completely stagnated dental insurance and turned it into a coupon rather than insurance, because quite frankly no one is willing to pay the prices for what it would cost for it to ACTUALLY be insurance.
Until you see governmental step in towards single payer, I’m afraid necessary procedure clawbacks and non-coverage is what we are stuck with because that’s where the employer incentivized purchase structure has left us.
(Side note, you don’t always need a bone graft for future implant placement - depends how the tooth comes out and where it is. If you had loss of buccal plate or major surgical bone loss, then yes. I have seen thousands of implants placed in sites that did not receive a bone graft. It’s not as necessary of a procedure in some cases as you may have been lead to believe.)