Are Biological Dentists Covered by Insurance? What I’ve Learned The Hard Way

Table of Contents

• Procedures vs. way of thinking
• In-network vs. out-of-network (PPO, HMO/DMO)

• Covered or partly covered with basic CDT codes
• Less likely paid or limited

• Pre-approval and treatment plans
• Reading EOBs and fighting denials
• FSAs, HSAs, and discount plans
• Questions I ask my dentist and insurance

• Paying myself and getting loans
• Why some biological options cost extra

1) The quick answer: it’s not simple but often yes (partly)

When I first wanted to know “Are biological dentists covered by insurance,” I thought I’d get a straight yes or no. I didn’t. I found out that insurance doesn’t see “biological” or “holistic” as a specialty. Insurance pays for things that have CDT codes. They don’t pay for the type of thinking or approach your dentist uses.

Here’s the good part. Most regular dental work done by a biological dentist uses the same CDT (billing) codes as any regular dentist. Cleanings, check-ups, X-rays, fillings, pulling teeth, crowns, root canals, implants, and deep cleanings all have standard codes. If your plan covers these, it usually does so if a biological dentist does them too. The tricky part is when you get into special treatments or extra steps. That’s when coverage gets thin quickly.

So the short answer: Yes for basic and some main treatments. No or maybe for “biological extras” like ozone, special testing, and some add-ons to surgeries.

2) How dental insurance really works with biological dentists

Procedures vs. way of thinking

This one idea helped me a lot. Dental insurance pays for specific treatments with codes, not for your dentist’s way of thinking, group, or style. They check codes, notes, and X-rays. They also have rules for how often things are covered and plan exclusions.

A few examples to show what I mean:

• A composite (white) filling uses D23xx codes. It’s the same, whether your dentist is in IAOMT or ADA.
• A crown, like D2740 (porcelain/ceramic), is still billed the same, even if your dentist uses zirconia for no metal inside. The lab material doesn’t make a new category for insurance.
• An extraction is just an extraction: D7140 or D7210 depending on how hard it is. If your dentist does a “clean” extraction, it’s still billed the regular way.

Where things are different:

• Ozone therapy has no regular CDT code. Insurance almost always says no because they call it experimental.
• Testing to see if you react to a dental material is almost never covered, since it’s not seen as needed.
• “Safe amalgam removal” (SMART) adds extra steps, but insurance usually pays for removal and replacement only, not for the extra safe steps.

I like the biological way, but I don’t expect the plan to pay for every part of it.

In-network vs. out-of-network (PPO, HMO/DMO)

Most biological dentists I found ask for their fee up front (fee-for-service). A lot are out-of-network. That doesn’t mean your insurance doesn’t help. It means your plan pays based on different (usually lower) rates.

• PPO (Preferred Provider Organization): This gave me the most choice. With PPO, I could see any dentist, send in the bill myself, and get back a part of the cost after my deductible. I still had to pay any difference between what the dentist charges and what the plan covers. PPOs also have yearly limits and sometimes waiting times for bigger treatments. Be careful about those.
• HMO/DMO (Health or Dental Maintenance Organization): You must pick a dentist from a set list. Seeing dentists out-of-network usually means no coverage at all. I rarely saw biological dentists on these lists.
• Employer plans vs. individual plans: Plans through work often pay you back at better rates than ones you buy yourself. Always read your plan details.
• Big insurers: I used Delta Dental, MetLife Dental, Aetna Dental, Cigna Dental, Guardian Dental, UnitedHealthcare Dental, Humana Dental, and Blue Cross Blue Shield. Each plan was different. The company name didn’t explain everything.

A tip that saved me money: Ask for the sheet that shows what out-of-network fees they pay, and check the max they’ll pay each year. Many dental plans top out at $1,000–$2,000 a year. If you need a lot of biological care, you need a plan to spread it out or use other ways to save.

3) What usually gets paid for vs. denied

I’ll keep this short and simple.

Covered or partly covered with basic CDT codes

• Exams and cleanings: D0120 (check-up), D1110 (adult cleaning). Most plans offer these as basic benefits. Many biological dentists skip fluoride, but if you want it, most plans pay for it.
• X-rays: D02xx group. If your biological dentist uses digital low-radiation X-rays, the code is the same.
• White fillings: D2330–D2394. More plans pay for white fillings the same as silver ones. Some only pay the silver price, and you pay more for white fillings. Always check: “Do you pay for white fillings on back teeth?”
• Crowns: D2740 porcelain/ceramic. Zirconia crowns are often billed this way. Major work like this is usually covered at 50–80% after your deductible if it’s needed. Make sure breaks or large old fillings are well-documented.
• Bridges/partials: Codes change based on type. Major work rules and usual limits.
• Extractions/oral surgery: D7140 (simple), D7210 (harder). Covered when needed. If your dentist uses extra cleaning or bone grafts, those might not be covered.
• Root canals: D33xx group. Many biological dentists still do root canals but pay extra attention to cleaning. Plans cover the main part of these if billed right.
• Implants: Coverage changes a lot. Some plans cover, some don’t. Attachment and crown are often covered if the main implant is. Check plan booklet for what’s not included.
• Gum therapy: D4341/D4342 (deep cleaning), D4910 (upkeep). Covered if needed and documented.
• Sedation/anesthesia: Covered as a different code during surgeries. IV sedation usually has lots of rules. I always asked before.

Less likely paid or limited

• Ozone therapy: Common for biological cleaning. Plans almost always say no, call it experimental. I always paid for this myself.
• Biocompatibility testing: Plans say no. I paid myself when I wanted to check a material.
• Metal testing/detox: Dental plans never pay for this. Medical insurance sometimes does with the right medical reason from a doctor.
• Nutrition advice: Dental plans almost never pay. Sometimes medical plans will if you have a diagnosis and proper provider.
• Safe amalgam removal protocol fees: The removal and filling work is paid, but safer steps are not.
• Cavitation surgery: Hard to get paid for. Only possible if you have good proof of a real problem. Never start without approval and notes.
• PRF/PRP: Platelet-rich fibrin or plasma sometimes fits into surgical codes, sometimes not. You have to check with the office.
• Sleep apnea mouth guards/TMJ devices: Dental plans usually say no. Sometimes medical insurance pays if you have a diagnosis and a sleep study. TMJ is a mix. I handled all this with my doctor and dentist together.
• “Metal-free” and other upgrades: The main treatment may be covered, but extra fees often are not.

4) How I get the most out of my insurance with a biological dentist

I made lots of calls and read lots of EOBs (Explanation of Benefits). Some habits helped me.

Pre-approval and treatment plans

Pre-approval is sometimes called “pre-treat estimate.” I always:

• Ask the dentist for a full treatment plan with tooth numbers, codes, and costs.
• Send it to my insurance for a pre-treatment estimate for major stuff like crowns, implants, and gum work.
• Make sure X-rays and notes are attached.
• Explain in the notes if it matters, like zirconia (no metal) vs. metal.

Pre-approvals aren’t promises. They just give me an idea what to expect, and I can plan better.

Reading EOBs and fighting denials

EOBs tell me:

• What dentist charged
• What plan allows
• What plan paid
• What I owe

If something is denied but seems like it should get paid, I appeal.

• I get a short letter from the dentist explaining why it’s needed. “Tooth #19 has a fracture. Full crown needed to stop more damage. See X-ray and photo.”
• Attach X-rays/photos.
• Point to the right code and my plan’s coverage.

Keeping it simple and direct works best. Timelines matter, so I set reminders to not miss the deadline.

FSAs, HSAs, and discount plans

FSAs and HSAs saved me. I use them for:

• Out-of-pocket parts of covered care
• Non-covered biological treatments (ozone, special material testing)
• Sedation or add-ons for surgery

You get a tax break with these. I plan big dental work with FSA/HSA years in mind. Sometimes I do bigger work early to use the year’s money.

Dental discount plans are not insurance. They offer lower fees with certain dentists. Some biological offices have their own clubs or take third-party discount plans. It never hurts to ask.

Questions I ask my dentist and insurance

Instead of “Do you take my insurance?” I ask:

• To the dental office:
• Are you in-network? If not, will you file for me or give me the bill I need?
• Can you give a detailed plan with codes and fees?
• Do you suggest any extra steps that aren’t covered? If yes, what do they cost?
• Can we get a pre-treatment estimate for big stuff?
• To the insurer:
• What are my out-of-network benefits for check-ups, basic, and bigger work?
• Do you cover white fillings for back teeth all the way or only pay the silver rate?
• Do you pay for implants, and what are the rules?
• What’s my yearly max and deductible?
• Are there time rules for cleanings, X-rays or crowns?

These questions help me plan instead of guess.

5) Real-life cost and payment tips

Paying myself and getting loans

Even with a PPO, I often paid the biological dentist first, then waited for insurance to pay me back. For bigger treatments, I used CareCredit (a payment card) or in-office payment plans so I didn’t have to pay it all up front.

Medicare and Medicaid: Medicare almost never pays for regular dental. Some Medicare Advantage plans add a little dental. Medicaid dental is different in each state. If you use these, call first.

Why some biological options cost extra

I once checked prices for a regular crown vs. a zirconia crown at two places. The biological office cost more. Some of the higher price came from the dentist’s longer time, careful steps, special gear (for safe removal), safer materials, and lab work.

For the lab part, the material and methods can change the bill. Biological dentists often like all-ceramic/no-metal lab work. Modern dental labs use special equipment and skilled techs for this. Advanced partners like a digital dental lab or a specialist zirconia lab help make crowns. Those details may not change what your insurance pays but can mean better results and higher bills.

I’m sharing these links to show the tech and skill that often come with metal-free choices.

6) Finding a biological dentist who takes insurance

How I looked:

• Use dentist directories: IAOMT, IABDM, Holistic Dental Association have lists. Check if they say how they handle insurance on their website or phone.
• Ask if they are good with out-of-network claims. A good front desk staff who know codes and bills makes a big difference.
• I pick places that give written price estimates with codes, tell me what won’t be covered, and help with pre-approvals.
• I sometimes went further away to get a biological dentist who could file claims.
• I read reviews, especially about billing and what others say about getting paid back by insurance.

7) Short cases from my notes

I keep little notes after finishing dental work. These three taught me the most.

Case 1: Changing out an old silver filling with white filling and a crown

Plan: Remove old, broken silver, put in a white core, then a zirconia crown on a cracked molar.

Result: Insurance paid for the crown and core after deductible. The dentist used extra safe rules for taking out the silver. Insurance paid for removal, but not for the extra safety fee. I used my HSA for that.

Case 2: Ozone during deep gum cleanings

Plan: Deep cleaning with ozone for better cleaning.

Result: Insurance paid the deep cleaning codes. Ozone was denied as experimental, so I paid for it. Healing was good, so I was happy with the extra cost.

Case 3: Implant with PRF

Plan: Single implant plus PRF (for healing), then attachment and crown.

Result: Insurance paid for the top part (attachment and crown) after a wait, and partly paid for the main implant. PRF was denied when billed alone, so I used FSA for that part.

What I learned: Pre-approvals helped me predict costs. Detailed notes from the dentist got more things paid. Using my FSA/HSA saved me on taxes. I expected to pay for extras and planned ahead.

8) Quick answers to common questions

• Do dental plans see a difference between “biological” and “regular”?

No, only codes and if the work is needed.

• Are white fillings paid for?

Usually yes, sometimes at the same rate, sometimes you pay the extra.

• Will they pay for zirconia crowns?

If needed, yes. Zirconia is usually the same code as any porcelain crown.

• Does insurance pay for safe amalgam removal steps?

It pays to take out and fix the filling, not for extra safe methods.

• Will insurance cover ozone?

Hardly ever. They call it experimental.

• Can I use FSA/HSA for things my plan won’t pay?

Yes, you can.

• Are biological dentists in-network?

Usually out-of-network, but PPOs will pay the out-of-network way. HMOs usually say no.

• Does Medicare pay for this?

Very little. Sometimes Medicare Advantage has a small dental plan tacked on.

• What about Medicaid?

Changes by state. Adults may get less coverage, kids usually have good basics.

• Are sleep apnea mouthpieces covered?

Often only by medical insurance, with a diagnosis and sleep study. Dental plans usually don’t pay.

• What about TMJ?

Depends. Some plans don’t cover it. Some need your doctor and dentist to work together.

• Are zirconia implants covered?

Depends on your plan, not the material. Check for exclusions and wait times.

• Can I fight a denial?

Yes. Keep it short, get a note from the dentist, and add X-rays.

9) Bottom line: make a plan that works for your health and wallet

In the end, it’s clear to me: Biological dentistry means safer materials and thinking about the whole body. Dental insurance means paying for standard treatments that meet their rules. There’s a lot of overlap, but not everywhere.

How I make it work:

• I check my PPO coverage for out-of-network care and plan for the yearly maximum and waiting rules.
• I get pre-approvals with good notes and X-rays for big work.
• I accept that some extras will be my job to pay. I use FSA/HSA if I can.
• I choose an office with a smart and helpful front desk for codes and bills.
• I fight denials that don’t make sense with short, direct info.
• Big jobs get spread out across years to make the most of my plan.

A thought that helps me stay calm: Insurance is just a helper for dental bills, not a magic answer. I use every benefit I can, but still put my health choices first.

Extra notes for accuracy:

• Insurance depends on CDT codes, your plan, and their rules for what’s needed. CDT is managed by the ADA, which dental insurance uses.
• Dentist groups like IAOMT and IABDM help biological dentists do things like safer amalgam removal and ozone for cleaning, but insurance doesn’t make extra payment rules for these ways.
• What I shared here matches what a lot of dental billing desk staff tell patients with major insurers like Delta Dental, Aetna Dental, Cigna Dental, Guardian Dental, MetLife Dental, UnitedHealthcare Dental, Humana Dental, and Blue Cross Blue Shield Dental. What’s paid really depends on your own plan, job, and state. Always check with your insurance!