Cosmetic dental procedures improve the appearance of your mouth, teeth, and gums. They include teeth whitening, dental implants, veneers, crowns, and bonding. Most cosmetic procedures are elective, meaning that they are not necessary. The cost of cosmetic dental procedures is often high and overwhelming.

However, you may receive partial or complete coverage if the procedure serves functional or health-related needs. Depending on the reason for your procedure, your dentist can write a detailed report to the insurance company to justify its necessity. Under the right circumstances, most insurance providers may cover a portion of the costs for a cosmetic procedure if it is also medically necessary.

Receiving insurance coverage can help you cut the costs of the procedures and restore your oral health. Before undergoing a dental procedure, you must be informed about what your plan covers, which makes cosmetic dental care more accessible. It also helps when discussing options with your dentist or insurance provider. Cosmetic procedures that the insurance can cover include:

Dental Bonding

Dental bonding is a cosmetic and restorative procedure in which a dentist uses tooth-colored resin to repair minor issues such as chips, cracks, or gaps. It is also performed when the roots are exposed or to fix a decayed tooth. The resin is placed directly onto the tooth, shaped to appear natural, and hardened with a curing light.

The procedure is typically completed in a single visit and often requires little to no anesthesia. While dental bonding is often done for cosmetic reasons, insurance usually covers it only when it is medically necessary. Therefore, you can receive coverage when you seek the procedure for:

  • Repairing a chipped or fractured tooth from an injury

  • Treating a cavity as an alternative to a traditional filling

  • Covering exposed roots due to gum recession

  • Protecting a tooth that has worn enamel

In these cases, bonding is considered a basic restorative procedure. Dental bonding typically costs $300–$600 in California per tooth. Simple repairs like small chips may run as low as $100–$400. More complex reshaping or high-end cosmetic work may reach $500–$800 per tooth.

Most dental plans cover 50% to 80% of the cost after the deductible. However, if you need the bonding to improve appearance, it is considered purely cosmetic and not covered. To qualify for insurance coverage for dental bonding, you will need pre-authorization. This means your dentist must submit supporting documentation before the procedure. They may include:

  • X-rays or intraoral photos

  • A treatment plan

  • A written explanation of medical necessity

If your insurance company denies the claim, you can appeal. Often, submitting stronger evidence can help get approval. Dental bonding is one of the more affordable procedures, even without insurance. However, knowing how to present it to your provider can significantly reduce out-of-pocket costs.

Dental Crowns and Bridges

Dental crowns and bridges repair or replace damaged or missing teeth. A crown is a cap placed over a tooth that has been weakened to support the tooth’s form, strength, and function. It is often needed after a root canal procedure or when a tooth is heavily decayed or cracked.

On the other hand, a bridge is used to “bridge” the gap when a tooth is missing. It includes inserting fixed crowns to attach the artificial tooth to adjacent teeth. The process for getting a crown or bridge usually involves two visits. During the first visit, the dentist:

  • Removes decay and shapes the tooth

  • Take impressions for a custom fit.

  • Places a temporary crown or bridge

At the second visit, the dentist fits and cements the permanent crown or bridge. Some clinics also offer same-day crowns using digital scanning and milling machines. Crowns are made of different materials, including metal, porcelain, ceramic, and zirconia. In California, dental crowns cost between $800 and $2,500 each. Bridges can range from $2,000 to $5,000 or more. The price depends heavily on the material used.

Metal crowns, made from materials like gold or other alloys, are known for their durability. Porcelain-fused-to-metal options offer a balance of durability and appearance. All-ceramic crowns look natural and are best for front teeth. Bridges using high-end materials like zirconia cost more.

Insurance will cover these procedures if they are medically necessary, such as:

  • Protecting a tooth after a root canal

  • Restoring a tooth with severe decay

  • Replacing a missing tooth that affects your bite

These procedures fall under primary restorative services; most insurance plans cover about 50% of the cost. However, there are often limitations:

  • Annual benefit maximums.

  • Materials. Some insurance plans will not fully cover porcelain crowns.

  • Waiting periods for new policyholders

Your dentist must submit documentation like X-rays and treatment notes to show that the restoration is medically necessary. Insurance does not cover crowns done purely for cosmetic purposes. Before you start treatment, you must submit a pre-authorization.

Dental Implants

Dental implants are titanium posts surgically inserted into the jaw to replace tooth roots. Once healed, a crown is then secured to the implant. This creates a permanent prosthetic that appears and acts like a natural tooth. Many people prefer implants over dentures or bridges because they are more stable and help preserve bone in the jaw. The process of placing dental implants includes the following steps:

  • Initial consultation and imaging. It involves a comprehensive dental examination. The dentist reviews oral health and uses imaging techniques like X-rays or CT scans to evaluate bone density. Additionally, they determine the precise placement of the implant.

  • Surgical placement of the implant into the jawbone. During this procedure, a titanium post is carefully inserted into the jawbone. It acts as a replacement root for the missing tooth and provides a stable foundation for the final restoration.

  • Healing period of 3–6 months for bone integration. After the implant is placed, a healing phase called osseointegration occurs. The bone fuses with the implant over 3 to 6 months, securing it firmly in place.

  • Placement of the abutment and crown. Once healing is complete, an abutment is attached to the implant. The connector piece holds the crown, the visible part of the artificial tooth.

Most plans exclude implants unless a strong medical necessity is established. Your insurance provider can cover the cost of your implants if you need them under the following circumstances:

  • You have tooth loss due to trauma or an accident.

  • You have tooth loss from periodontal disease or decay.

  • When other options, like bridges, are not viable for your condition

Dental implants in California range from $3,000 to $6,000. Sometimes, the price is higher when you need additional procedures like a bone graft. Most insurance plans list implants as major restorative procedures, and they can cover up to 50% of the treatment.

However, not all plans include implants in their coverage. Some only cover the crown or abutment and exclude the surgical portion. To improve the chances of coverage, your provider must submit detailed documentation, including:

  • Diagnostic images

  • A treatment plan and timeline

  • A letter explaining why implants are necessary when compared to other alternatives

Your insurance policy could also weigh costs against bridges or dentures to confirm that an implant is the most cost-effective option. Implants are a more expensive treatment. But if justified appropriately, this can mean a significant reimbursement.

Orthodontic Treatment (Braces or Invisalign)

Orthodontics treats spacing, crowding, and bite problems by repositioning and aligning the teeth. This may be achieved through traditional metal braces or clear aligners such as Invisalign. A visit for consultation and diagnostic images is usually the first step, followed by the formulation of a customized plan.

Dental insurance may cover orthodontics, especially when it is needed to fix functional problems, like:

  • Difficulty chewing or speaking

  • Pain due to jaw misalignment

  • Severe bite problems

In these cases, insurance considers the treatment medically necessary. However, you cannot receive coverage if the treatment only aims to improve your appearance. Orthodontic benefits are often separate from regular dental benefits. Instead of paying a percentage per visit, plans often offer a lifetime maximum, such as:

  • $1,500–$3,500 per person

  • 50% coinsurance on approved treatment

  • Often limited to children or teens.

To receive coverage approval, you must submit:

  • Panoramic X-rays and photos

  • Written justification from the orthodontist

  • A complete treatment plan with estimated costs and duration

Some plans also have age limits and waiting periods. Therefore, you should always check your policy before starting. With careful planning and documentation, braces and Invisalign may sometimes qualify, especially for children or teens.

Gum Surgery (for Medical Purposes)

Gum surgery treats advanced gum disease or prepares the mouth for other dental treatments. These procedures go beyond regular cleanings and include:

  • Flap surgery to lift gums and clean deep pockets

  • Gum grafts to cover exposed roots and stop recession

  • Crown lengthening to expose more tooth surface for crowns or fillings

  • Bone grafting is necessary when the disease has damaged the jawbone.

Surgical intervention is medically necessary in chronic periodontitis or when destruction of the gums jeopardizes tooth stability. Gum surgery is usually covered by insurance when done for the treatment of:

  • Advanced gum disease

  • Tooth mobility due to bone loss

  • Severe gum recession that causes sensitivity or decay risk

Most insurers classify gum surgery as periodontal treatment, and they cover up to 50% of your treatment cost. Plans also apply this to your annual maximum benefit. To receive insurance approval, your dentist or periodontist must submit evidence such as:

  • Pocket depth measurements

  • Periodontal charts

  • X-rays showing bone loss or damage

Purely cosmetic gum reshaping is excluded from coverage. That includes procedures only to improve a "gummy smile" or reshape the gum line for appearance. With proper documentation, necessary gum surgeries are regularly approved.

How to Get Insurance to Cover Cosmetic Dental Procedures

Insurance does not cover all cosmetic dental work. But if it serves a functional or health-related need, you may receive partial or complete coverage. The following are the steps to follow to request insurance coverage for cosmetic dental procedures:

  • Consult with your dentist. Before undergoing any dental procedure, you must discuss your goals with your dentist. A cosmetic procedure may be medically necessary to address functional issues like tooth damage, misalignment, or chewing problems.

  • Submit medical documentation. Your dentist will document the medical necessity for your procedure. These records consist of x-rays, intraoral photographs, and a history of dental records. They will also write clinical notes justifying the need for the procedure beyond cosmetic reasons.

  • Submit a pre-authorization request. Before starting cosmetic treatment, your dentist will submit a pre-authorization request to your insurance provider. It includes diagnostic codes, treatment plans, and documentation proving medical need. Pre-authorization does not guarantee payment. However, it helps estimate potential coverage.

  • Wait for an insurance review. After submitting your preauthorization request, the insurance company will review it. They may approve, deny, or request more information. If approved, they will estimate coverage and expected out-of-pocket costs. The estimation lets you know the coverage you can receive for a given procedure. Additionally, it helps you make plans on how to cover the balance.

  • Appeal if necessary. If the company denies your request, you or your provider can file an appeal. You can strengthen your case by adding supporting records or seeking a second opinion. Some appeals are approved after further review.

  • Continue with the treatment and file the final claim. Once the procedure is performed, your dentist will send the final claim to your insurance company after approval. You will be responsible for whatever your insurance does not cover.

Find Expert Cosmetic Dental Services Near Me

Cosmetic dentistry can enhance your smile and boost your confidence. In California, these procedures are either purely cosmetic or medically necessary. Whether insurance will pay for your treatment is determined by this categorization. Most plans do not cover purely cosmetic procedures like teeth whitening or veneers.

However, insurance can assist with crowns, braces, or implants that restore oral health and function. You must prove the necessity of your procedure before receiving insurance coverage. Your dentist can help provide documentation to support coverage requests. Additionally, some dental offices offer financing options to make cosmetic treatments more affordable.

Knowing your options can save time and money. With the correct information, you can make confident choices about improving your smile without unnecessary financial stress. At Los Angeles Advanced Dentistry, we offer our clients safe and reliable cosmetic dental services. Contact us at 310-361-2080 from Los Angeles, CA, to book an appointment.