Dental plans usually have a list of what they cover regardless of the patient’s needs. Dental Plan companies make a contract with your employer to provide dental benefits.
Over the years, benefits have shrunken to a smaller list. The average maximum allowance is the same as 30 years ago, and the Dental benefit companies keep adding a long list of requirements from the dentist/patient before they even pay for the allowed benefits.
Let us review 2 different patients:
Patient 1 is a 30 year old man who brushes and flosses as recommended. However he develops a lot of tartar and is starting to show signs of periodontal disease. To slow down the bone loss process the dentist recommends for the patient to have the tartar removed more frequent by coming in 3 times a year for professional dental cleanings. But patient 1's dental plan only covers 2 times per year, and now has to make the decision to pay for an additional cleaning out of pocket. If he comes as recommended, the dental work he has invested in (fillings, crowns. etc.) will significantly harbor less bacteria around them and will keep from replacing them too often. This saves money, time and will keep teeth from being extracted prematurely.
Patient 2 is a 45 year old lady who has recently changed dental benefits through work. She comes in for her next check up and is recommended to have a crown replaced due to a space discovered between the crown and tooth. This is where bacteria has been leaking into the tooth and has created a cavity under the crown. Patient 2's new dental plan has a 12 month waiting period for this type of dental work and she decides to wait until the waiting period is over. Weeks later, she comes with pain and other symptoms. After a new evaluation it is now indicated for her to have a root canal done on the same tooth. This is a common situation for patients who decide to have dental work done ONLY if their dental plan helps pay for it. Now, the patient not only has to have the crown done immediately but she added an additional procedure and pain to the situation.
In short, what the Dentist recommends is not based on the dental plan you have. It is based on your individual needs. The Dentist will guide you through risks, benefits and all the options you have to keep your dental health up to par.