Why are dentists paid so much
All dental health insurance benefits at a glance
For adults, statutory health insurances pay for two dental check-ups per year and a tartar removal, i.e. the removal of hard and soft plaque. Every two years the health insurance companies cover the costs of an early diagnosis of periodontal disease.
Many health insurance companies also provided grants for professional tooth cleaning, which is subject to a fee.
For children between the ages of 6 and 18, two dental check-ups are paid as well as a caries-prophylactic filling of tooth furrows (fissure sealing) of the two permanent molars in front of the wisdom teeth. Between the ages of 3 and 6, the statutory health insurances take over three dental early diagnosis examinations. The first examination takes place from the 34th month of life and the other two examinations until the end of the 6th year of life. There must be at least 12 months between the individual examinations. In addition, children who are at high risk of tooth decay are entitled to fluoridation.
Since July 1, 2019, there are new statutory benefits to prevent tooth decay in small children. According to this, small children between the ages of 6 and 34 months are entitled to three early diagnosis examinations. The examinations are timed to match the U examinations, but there must be at least 4 months between the individual examinations. Furthermore, there is a right to fluoridation twice per calendar half year to harden tooth enamel.
The performance of the preventive examination can be entered in a bonus booklet. For children and adolescents, two stamps per year are required as part of individual prophylaxis, and at least one stamp per year for adults. This can offer financial advantages later when it comes to the subsidies for dentures.
More information: What provision does the health insurance company pay for?
The statutory health insurance companies reimburse so-called composite fillings made of tooth-colored plastic in the anterior region. In the posterior region, pregnant and breastfeeding women as well as those with statutory health insurance with an amalgam allergy, patients with severe renal insufficiency and children up to the age of 15 are entitled to a free plastic filling.
Even if patients opt for a chargeable filling, the statutory health insurance companies still cover the costs of the statutory alternative, i.e. the patient only has to pay the difference between the health insurance variant that is free of co-payments and the service that is subject to a charge. In this case we will then conclude an additional cost agreement.
In the event of defects in the fillings for which the patient is not to blame, the statutory health insurances assume a two-year guarantee period. The dentist has to correct the defect free of charge or insert a completely new filling.
More information: Caries - what does the health insurance company pay?
Root canal treatments
The scope of services provided by the health insurance company includes root canal treatment and the removal of root tips (resection) in the anterior and posterior area, provided the affected tooth is classified as worthy of preservation. The cleaning, filling and sealing of the root canals are reimbursable services of a root canal treatment.
As a rule, it must be ensured that the root canals can be prepared and filled up to or near the root tip. In the case of the posterior posterior teeth, there are three aspects to consider during a root canal treatment. It is insured if a closed row of teeth can be obtained, if the treatment prevents a row of teeth from being shortened backwards on one side and if an existing denture can be retained. 1, 2 (1. https://www.kzbv.de/wann-ist-eine-wurzelverarbeitung-er needlich.85.de.html, 2. https://www.g-ba.de/downloads/62-492-78 /RL-Z_Treatment_2006-03-01.pdf)
A prerequisite for a successful root canal treatment is that the root canal is precisely measured before the actual treatment. The standard method paid for by the registers is to determine the length based on x-rays.
More information: Root canal treatment - what does the health insurance company pay for?
Treatment of periodontal disease
The health insurance companies cover the costs if periodontitis requires treatment. This means that there is a gum pocket depth of 3.5 mm or more. A written application must be submitted to the health insurance company before treatment begins. For this purpose, the dentist creates a treatment and cost plan that the patient submits to his health insurance fund for review and approval. So far, the statutory health insurances have only covered the costs of the main treatment, i.e. acute periodontal disease.
But this is expected to change from July 2021. From then on, the health insurance companies will also cover the costs of pre- and post-treatment. There are changes especially in the follow-up treatment. In the future, insured persons can take advantage of follow-up care (supportive periodontal therapy) for a period of two years after completing active treatment. Under certain conditions, this can be extended by a further six months. (https://www.kzbv.de/pressemitteilung-vom-17-12-2020.1469.de.html)
More information: What costs does the health insurance company cover for periodontal treatment?
Treatment of misaligned teeth (orthodontics)
In children up to the age of 18, the orthodontist checks the severity of the misaligned teeth using five orthodontic indication groups, or KIG for short. From KIG 3, the statutory health insurance companies bear the costs of the treatment. Depending on the requirements, the specific scope of services includes either a removable plastic clip with metal brackets or a fixed clip with stainless steel brackets.
In adults, orthodontic treatment is only accepted for severe jaw misalignments that also require orthodontic treatment.
In the case of children, the parents must initially pay 20% of the costs of the statutory treatment themselves, but will be reimbursed if the treatment is successfully completed. If two or more children are receiving orthodontic treatment at the same time, the parents only have to pay 10% in advance.
More information: Orthodontics, what does the health insurance company pay?
Different rules apply to dentures than to other dental care.
The health insurance company participates in the dental prosthesis treatment with a so-called fixed allowance. The starting point for the grant is the test result, the so-called finding. Standard care (standard therapy) is defined as medically necessary for each finding. The health insurance company bears 60% of the costs of this standard care, also known as a fixed allowance. The patient has to bear the rest of the costs (exception: see hardship regulation).
The amount of the costs also depends on whether the annual check-ups can be proven in the bonus booklet. If a check-up has been carried out once a year for 5 years, the subsidy from the health insurance increases to 70%. If 10 years can be proven, the grant increases to 75%. If a crown or bridge is necessary in the posterior area, non-precious metal is the standard treatment, for example.
More information: Own contribution and fixed allowance for dentures.
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