I'd be shocked if you find any dental insurance that covers more than 2 cleanings per year unless you go the concierge route which would be a lot more than the price you listed.

Dental schools maybe?

Have you gotten a second opinion?

Changing your insurance before changing your dentist is kind of wild.

I agree that you'll be hard pressed to find any dental insurer that will cover four cleanings a year. Maybe you could get the other two at either the Tufts or BU dental schools? I'm sure their wait-lists are long though and you must commit to a much longer appointment since they're teaching schools.

MassHealth can grant you 4 cleanings per a year if you file a an appeal with your dentist given that you have the necessary need for it.

I am also trying to source a dentist that charges a decent price for a cleaning ($50-60).

I found recommendations for a few dental schools (BU, Tufts) but people say that it takes hours to get anything done.

I found a few cheap places (Gentle Dental for example) but they also seem to have bad reviews.

This is interesting.

I am going next month for an out of pocket cleaning.

I will mention it to him and see if he can help?

Do you have experience yourself with this process?

My dentist advocated it for it because of my oral reconstructive surgery and dental implants.

Another scenario: I have a buddy who gets contacts covered because of his bulging eye and can’t wear traditional eye glasses.

Talk to your insurance, maybe

My BCBS plan covers 3 cleanings per year

I’ve always found gentle dental to provide a mediocre, but consistent cleaning. Very affordable too

Could you get on a spouse/significant others dental insurance? Maybe each would cover 2?

I was reading that dual insurance coverage is not straight cumulative.

We might still have the 2 cleaning a year, but will double check.

I get four per year and have had insurance with both delta and blue cross. Because I had scaling done a few years ago the 4x per year was covered. Not sure if that’s the case with you but I can find out more if that sounds familiar

Sorry to be blowing up your post but the reality is dental hygienists are getting $50 per hour. When you tack on overhead costs you’re not going to get a cleaning anywhere near what you’re expecting

Your dentist is ripping you off. I too need cleanings every 3 months, but my dentist bills the extra two at the same rate as she is reimbursed by insurance . Your dentist is charging you "list" price, the reimbursed rate is about half that.

I had that recommended but haven't done yet.

Will discuss with my dentist, it seems the best way forward hopefully he can help.

Next month will be my first time doing the out of pocket cleaning.

Will ask him if he can do what you're saying, thank you.

if there’s a periodontal reason you need four cleanings per year (I’m assuming it has something to do with your gums) then your dentist should be able to make the argument that it’s preventive maintenance to the insurer and get the other two visits covered. if your dentist can’t or won’t do that it’s probably a sign that they’re not good patient advocates and you should find someone else.

no insurer will cover four cleanings a year unless your dentist fights for it, because private insurance is a Ponzi scheme that doesn’t work and needs to die.

Yes. Check if your insurance has clauses that say dentist has to bill you the insurance rate for services past your annual limits.

If you need scaling get it done asap. If your dentist is recommending it with cleanings 4x per year your gum recession is likely bad. A scaling will get the gunk that’s accumulating underneath the gum line and will improve your mouth hygiene. It will also qualify you for four free cleanings per year

You will still have two. The two plans coordinate benefits so the other plan tries to pay the amt not paid by the primary plan for the same service. It does not mean you have double the frequency of services.

Try Tijuana. Lot of San Diego residents do that.

Just be sure to check the extra cost of an insurance plane vs. the amortized costs of the cleanings over time. Four cleanings a year at $180 each works out to $60/month. Don’t pay more than that for insurance.

Good luck finding an adult dentist that takes MassHealth though.

MassHealth could be amazing if doctors are forced to accept it; having a certain % of your patients be on MassHealth for subsidies.

Dental insurance isn’t really insurance, it’s more of a discount card. You could try negotiating a cash discount with another dentist.

I have been with Delta, and they covered mine when I needed cleanings 4x a year. It came down to how the dental office coded the visits. As it was mandated by my dentist, I had no issues.

You are confused between prophy code and perio maintenance code. If you did a SRP and on 3 months recall for cleaning (perio maintenance code gonna be billed instead of prophy).

Basically routine 2 times per year covered is D1110. After the SRP, your 3 months service would be filed as D4910. Check your insurance on how they cover that code.

Running a dental clinic is extremely expensive, you wouldn't find places charging $50-$60 per cleaning anymore, even if you do, I would be very skeptical they doing good work...

> So what is the actual difference between prophylaxis and periodontal maintenance? The answer is simply determined by confirming what was actually done on behalf of the doctor’s diagnosis. Was it only scaling? Was it scaling and polishing? What and where was root planed? It is here that the actual definitions from Current Dental Terminology will be helpful.

>D1110 prophylaxis – adult Removal of plaque, calculus and stains from the tooth structures in the permanent and transitional dentition. It is intended to control local irritational factors.

>D4910 periodontal maintenance This procedure is instituted following periodontal therapy and continues at varying intervals, determined by the clinical evaluation of the dentist, for the life of the dentition or any implant replacements. It includes removal of the bacterial plaque and calculus from supragingival and subgingival regions, site specific scaling and root planing where indicated, and polishing the teeth. If new or recurring periodontal disease appears, additional diagnostic and treatment procedures must be considered.

I see an academic dentist. Though she has me see the dental hygienist over the past few years

Work in a dental office. After an SRP, scaling and root planing or also known as a deep cleaning, most patients are placed on a 3 month periodontal maintenance. That is seen as a different under insurance frequencies than a regular prophy which is only 2 times per year usually.

I work in a dental office. Has nothing to do with how offices “code” things. I’m so tired of patients thinking it’s the fault of the office because things get denied sometimes. The exact codes are billed on the date of service the services are rendered, there is no trick or sneaky thing offices do to get cleanings covered 4 times a year for patients. It has to do with your plan’s frequency limitations. Some plans allow 4 cleanings a year, like yours.

Not necessarily true. Some plans only cover 2, the other 2 will need to be paid out of pocket. Doesn’t automatically qualify you. Check with your insurance and dental office.

While I don't work in a dental office and I know certain insurance plans have a limitation on how many of something or what is covered, I have also been explicitly told both by my service providers, i.e. the dental or doctor's office, and my insurance that applying the right/correct code makes a difference in coverage. I could be being gaslit by both sides, but I'm just sharing what my experience has been and what I have been told. 🤷‍♀️

This is the answer. His/her office probably doesn’t know how to code it

As others have said on this post you don’t get “cleanings” after periodontal work you get perio maintenance which is covered every three months

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Are you saying I have two insurances?

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I go to the dentist four times a year. The trick was to be diagnosed with periodontal disease, which often requires a trip to the periodontist for scaling and planing. Then every other time is charged as a periodontal upkeep, alternating with semiannual cleanings.

But if you do two regular cleanings and two gentle dental cleanings... wouldn't you be okay? And also what about a legit electric toothbrush.

I was an asshole and my teeth were bad, two deep cleanings and they want follow ups but my hygienist is an absolute rockstar and hooked me up with a dope toothbrush. Either way a really nice toothbrush is way cheaper than $180.

Windsor dental clinic through Cambridge health alliance takes masshealth. They’re great.

I had a fantastic dentist when I lived in NY up until 4 years ago. $49 for a cleaning only, no exam, it was awesome, I would go every 4 months and get just one exam per year. Now in MA, the cheapest I could find for a cleaning was $125.

You can do it for free if you go to the students but it will take a lot longer

Dental insurance covering 2 cleanings/year is standard. Get a flexible spending account and you can pay for the extra cleanings from that.

I don’t think most if any plans would cover more than 2 since ADA recommends every six months. Most plans would be up to $5k (more for couples or families) and 2 cleanings (some only cover 1 annual visit). If you have an HSA you could use that to pay for additional visits, but you could also check with Tufts Dental School. If you’re willing to be worked on by a dental student, you can get very cheap/free dental care

In what universe is $50-60 for a 40 minute cleaning a decent price. The salary of the hygienist, plus rent, equipment and consumables, the cost of a dentist to supervise, liability insurance…suggest you go to a dental school

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The frequency is a contract limitation between the employer and the insurance company. The dentist will get nowhere fighting for more than the contract allows.

You would still only have two covered. The two plans coordinate benefits. The other plan tries to pay the amt not paid by the primary plan for the same service. It does not mean you have double the frequency of services.

The other commenter who works in dental billing is correct. There are frequency limitations on codes and a basic dental hygiene cleaning has only two codes for a basic prophy which is hand scaling and polishing: one code or adult patients (14 and up) and one for pediatric. A hygiene exam (w Dentist) is a separate code, fluoride is another. If your plan only covers 2 prophys per year (either 2x calendar yr or 2 6mo apart) and you're getting 4 for free your dental office is committing fraud by coding 2 of them as something else you have coverage for to get the insurance money. Root scaling? You'll need to look at your coverage and benefits and check the EOBs your carrier sends you after each service. If you only have 2 included in your plan and go 4 times for the dame service it should be coded exactly the same for all 4 visits. Fact.

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Yeah MA is the worst for these things