Dental Insurance Out-of-Pocket Calculator

Your share of a dental bill is the deductible you still owe, plus your coinsurance on the rest, plus anything the plan won’t pay: the part above your annual maximum, the gap when the plan pays for a cheaper alternative, and, out of network, the gap between the plan’s allowance and the dentist’s fee. During a waiting period, or when a missing tooth clause applies, the plan pays nothing at all. The calculator above does that sum on your own plan’s numbers, one procedure at a time, and says which rule added most to your share. With its example figures (a $1,387 crown fee, a $50 deductible, 50% coinsurance and $700 left of a $1,000 maximum), the plan pays $668.50 and you pay $718.50. It is part of our dental insurance guides.

General information about costs, not dental, medical, insurance, tax or financial advice. Your dentist decides what treatment suits you; your plan’s documents and a pre-treatment estimate decide what it pays.

What to enter, and where to find it

Every number comes from your own paperwork: the dentist’s written treatment plan, your plan’s summary of benefits or brochure, and any explanation of benefits (the statement the plan sends after a claim) or pre-treatment estimate you already have. The examples in the boxes come from real plan documents we read on 11 November 2026, named each time. They are not what “most plans” do; plans differ a lot, as the table further down shows.

1. Dentist’s fee. One procedure per run: a crown, a root canal, an implant post. Treatment plans list each procedure on its own line with a code number, so take the fee from that line.
2. In or out of network. An in-network dentist has a contract with your plan and has agreed to its fees. GEHA’s 2026 federal dental brochure puts it simply: a preferred dentist “has agreed to limit charges to our maximum allowed charge”, while “Non-PPO providers have no agreement to limit what they will bill you” (p. 11).
3. Allowed amount. The most the plan counts for that procedure; plan brochures call it the plan allowance or the maximum allowable charge. In network, it is usually the fee you are billed. You will find it on a pre-treatment estimate or an explanation of benefits. If you don’t know it, leave 0 and the tool uses the dentist’s fee, which can overstate what the plan pays out of network.
4. Cheaper alternative (optional). Some plans pay as if a less costly treatment had been done. If your estimate shows that, enter the allowed amount for the cheaper treatment. More on this rule below.
5. Deductible still to pay. The amount you pay each year before the plan starts paying for the kinds of care it applies to. Enter 0 if you have met it, or if your plan waives it for this care (GEHA’s High Option has no deductible at all in 2026, p. 15).
6. Your coinsurance. The percentage of the allowed amount you pay for this class of care. Plans print it as “you pay” by class: preventive, basic, major. Cigna’s Dental 1000 summary (form 888306, 8/25) says you pay 50% after the deductible for major work such as crowns; the MetLife Federal Dental Plan’s 2026 Standard Option says 65% in network and 80% out.
7. Annual maximum and the amount used. The most the plan pays for you in a plan year. Enter 0 if your plan has none. Your plan’s member site, a call to the plan, or your last explanation of benefits shows how much is used.
8. Waiting period. Tick it if your plan makes new members wait for this class of care and the wait isn’t over.
9. Missing tooth clause. Tick it if the procedure replaces a tooth that was missing before your cover began and your plan won’t pay for that.

How the sum works

The calculator follows the order the plan documents describe. Each step is plain arithmetic on what you entered.

1. The bill. In network, the bill is the allowed amount (or the fee, if you left the allowed amount at 0). Out of network, the bill is the dentist’s fee.
2. The amount the plan works from. The allowed amount, never more than the fee. GEHA’s brochure bases coinsurance “on either the billed charge or the plan allowance, whichever is less” (p. 15). If you entered a cheaper alternative, the plan works from that smaller amount instead.
3. The deductible comes off that amount first, up to what you still owe.
4. Your coinsurance is your percentage of what is left. The plan’s share is the rest.
5. The annual maximum caps the plan’s share at what is left of the maximum. Anything above the cap is yours.
6. A waiting period or missing tooth clause sets the plan’s share to zero.
7. You pay the bill minus the plan’s share. The calculator splits your share into six parts (deductible, coinsurance, above the maximum, gap to the cheaper alternative, out-of-network balance, not paid), and the largest part is the “rule that added most to your share”.

The tool counts only the plan’s payments against the annual maximum. Some plans count more: the GEHA and MetLife 2026 federal brochures say covered charges credited to the deductible “are also counted towards the Plan maximum” (GEHA p. 15, MetLife p. 22). If your plan works like that, the amount left after treatment will be lower than the tool shows.

Worked example: a crown, in network

General information about costs, not dental, medical, insurance, tax or financial advice. Your dentist decides what treatment suits you; your plan’s documents and a pre-treatment estimate decide what it pays.

The calculator opens with a porcelain or ceramic crown, usually billed as D2740. Code numbers are from the CDT Code, maintained by the American Dental Association; the descriptions here are our own. The plan terms are those printed in Cigna’s Dental 1000 summary of benefits (form 888306, 8/25): a $50 deductible per person, 50% coinsurance for major work and a $1,000 plan maximum. That $300 of the maximum is already used is our assumption.

The fee comes from published crown figures. They differ, and they measure different things, so here they are side by side. We don’t average them, and none of them is what your dentist will charge.

Source and who publishes it	Porcelain or ceramic crown (D2740)	Date	Why it may lean
Humana, an insurer	$1,387 per crown, Orlando, Florida only	Page updated 1 Jun 2026 (its pricing tool accessed 13 May 2026); read 11 Nov 2026	Sells dental plans; figures from its own dental pricing tool for one city
CareCredit, a lender that finances dental work	$1,399 average ($915 to $3,254) per porcelain crown	Article of 15 Nov 2024; read 11 Nov 2026	Sells financing for the procedure; research it paid for (by ASQ360°, 2024); excludes the first visit and any extraction
Pearl, a dental software company’s cost guide	$1,560 average ($1,015 to $2,670)	Updated May 2026; read 11 Nov 2026	Says it is based on ADA fee survey data; method not shown
Delta Dental Plans Association, an insurer group	$1,100 to $2,000 for a permanent crown, out of network, no material split	No page date; “2023 Delta Dental internal data”; read 11 Nov 2026	Insurer; out-of-network claims framing

Step	Sum	Result
Bill (in network, allowed amount unknown, so the fee)		$1,387.00
Deductible still owed	$50 of $1,387	$50.00 yours
Your 50% coinsurance on the rest	50% x $1,337	$668.50 yours
Plan’s share before the maximum	$1,337 – $668.50	$668.50
Maximum left before treatment	$1,000 – $300	$700.00, so no cap this time
Plan pays		$668.50
You pay	$50 + $668.50	$718.50
Maximum left after	$700 – $668.50	$31.50

Change one number and the answer moves a lot. With $900 of the maximum already used, the deductible already met and the same crown at 20% coinsurance, the plan’s share would be $1,109.60 but only $100 is left, so the plan pays $100 and you pay $1,287. Inside a 12-month waiting period, you pay the whole $1,387. Our crown cost guide sets out what a crown fee includes and why quotes differ.

Five rules that change the answer

The annual maximum

Once the plan has paid its yearly maximum for you, it pays nothing more until the plan year starts again. Delta Dental of Iowa’s individual policy (form INDPLATPR-012027) says: “No further benefits are payable once the Benefit Period Maximum or Annual Maximum has been met” (p. 13). CareQuest Institute, an oral health foundation, says in Maxed Out (February 2026) that you then pay all further costs for the rest of the plan year, usually a calendar year, and that most plans offer a maximum of $1,500 or more. In its survey, 12% of adults with dental insurance said they had reached or gone over their maximum in the past year. CareQuest also notes that many plans don’t count preventive care such as cleanings against the maximum; your plan’s documents say whether yours does.

Some plans have no maximum: GEHA’s 2026 federal High Option has “an unlimited annual benefit maximum” for its Class A to C services (p. 16). Some add a smaller limit inside the maximum: Delta Dental’s 2026 federal High Option limits implants to $2,500 a year, which “counts toward the annual benefit maximums” (p. 16). If your procedure has a separate limit like that, enter whichever is smaller: what is left of that limit or what is left of the maximum.

Waiting periods

A waiting period is the time you must be covered before a class of care is paid. Delta Dental of Iowa’s policy, for example, makes you wait six consecutive months for root canals and gum treatment and 12 for crowns, bridges, dentures and implants (p. 10). It gives credit for earlier dental cover that included major services, with no gap over 63 days. Other plans have none: the three 2026 federal (FEDVIP) brochures we read, from GEHA, MetLife and Delta Dental, don’t use the words “waiting period” anywhere.

HealthCare.gov warns that “Separate dental plans can have waiting periods before they start to cover services for adults”, and that you pay premiums during the wait. In CMS’s 2026 public use files for the 30 states on HealthCare.gov, 199 of the individual stand-alone dental plan designs state a 6-month wait for adult basic care and 105 state a 12-month wait for adult major care in their benefit text; many others mention a wait without its length or don’t mention one there, so read your own plan’s brochure.

The missing tooth clause

Some plans won’t pay to replace a tooth that was already missing when your cover began. Cigna’s Colorado contract for Dental 1000 (evidence of coverage, form CO DE003 1-2025) says: “There is no payment for replacement of teeth that are missing when a person first becomes insured” (p. 18). The same contract pays for part of a bridge that replaces both kinds of teeth: only the false teeth for teeth extracted while the person was insured. The three 2026 FEDVIP brochures and the Iowa policy have no such clause. Our missing tooth clause guide goes through the wording plan by plan.

The cheaper-alternative payment

Plans call this the alternate benefit (GEHA’s 2026 federal brochure uses that name, p. 14); the American Dental Association’s ADA News (2 June 2026) calls the same kind of contract wording least expensive alternative treatment (LEAT). When two treatments could both be used, the plan pays as if the less costly one had been done. Your dentist decides what is clinically suitable for you; this rule only decides what the plan pays. The MetLife 2026 federal brochure gives this example: when a silver (amalgam) filling and a tooth-colored (composite) filling would both be acceptable on a molar, it may pay on the amalgam. It adds that the dentist may charge you the difference, “even if the service is performed by an In-Network dentist” (p. 18).

For one surface on a back tooth, the tooth-colored filling is usually billed as D2391 and the silver one as D2140. Here is the sum with Cigna’s published averages, about $191 for a composite filling and $160 for amalgam per tooth, without a number of surfaces or tooth position (Cigna, an insurer, citing the ADA Health Policy Institute’s 2022 fee survey; read 11 Nov 2026), and 20% coinsurance with the deductible met. The plan pays 80% of $160, which is $128. You pay $63: $32 coinsurance and the $31 gap. Other published figures differ: CareCredit, a lender, publishes $226 for a composite filling and $139 for amalgam (September 2024), and Humana publishes $217 for a one-surface tooth-colored filling on a back tooth in Orlando only (updated June 2026).

In or out of network

GEHA’s 2026 brochure works it through on one page (p. 16). A dentist charges $120 for a basic service and GEHA’s allowance is $100. In network, you pay your 20% of $100, which is $20, and “your PPO dental practitioner will not bill you for the $20 difference”. Out of network, you pay the same $20 plus the $20 difference, $40 in all. Cigna’s Dental 1000 summary gives a sharper case (p. 6): an out-of-network dentist charges $100 for a filling, Cigna’s contracted fee is $50, and at 50% Cigna pays $25, so “your total out-of-pocket cost could be $75”. Charging you that difference is called balance billing. Both examples give the same answers in the calculator.

One exception to watch: the fee limit in a network contract may not hold when the plan pays nothing. Delta Dental of Iowa’s policy says that when it pays no part of a service (a waiting period, an unmet deductible, a maximum already reached), its network dentist “is not limited in the amount of payment they may collect from you” (p. 7). Delta Dental’s 2026 federal brochure, by contrast, says you are not responsible for charges above its network allowance “unless you consent in writing” (p. 12), and names no such exception. If your plan will pay nothing for a procedure, ask the office which fee it will charge. If it is the full fee, leave the allowed amount at 0.

Five real plans, side by side

Here is how far the numbers you type in can differ, from plan documents read on 11 November 2026. This is not a ranking and not a recommendation: these are examples of the rules, and your own plan’s documents decide.

Plan document	Deductible	You pay, major work	Annual maximum	Waiting periods	Missing tooth clause
GEHA Connection Dental Federal, High Option, 2026	None	50%	None (unlimited)	None in the brochure	None in the brochure
MetLife Federal Dental Plan, Standard Option, 2026	$0 in network; $100 out	65% in network; 80% out	$2,000	None in the brochure	None in the brochure
Delta Dental’s Federal Employees Dental Program, Standard Option, 2026	$0 in network; $75 out	65% in network; 80% out	$1,500 in network; $1,000 out	None in the brochure	None for teeth lost before cover (teeth that never formed aren’t a benefit)
Delta Dental of Iowa, Individual Platinum Prime policy, 2027 form	$25 PPO; $100 Premier; $175 non-participating	50% for crowns (60% non-participating); 60% for implants	$2,000	6 months for root canals and gum care; 12 for crowns, bridges, dentures, implants	None found
Cigna Dental 1000, summary 8/25; Colorado contract 2025	$50 per person; $150 per family	50% after the deductible	$1,000	“Waiting periods may apply” (length not in the summary)	Yes, in the Colorado contract

You may see “dental plans pay 100/80/50” (all of preventive, 80% of basic, 50% of major) given as the rule. Some plans do pay that way: GEHA’s High Option is one. But MetLife’s federal Standard Option leaves you 45% of basic and 65% of major work in network, and among the 2026 individual stand-alone dental plan designs on HealthCare.gov, the in-network share for adult basic care was 50% in 233 designs and 20% in 100 (CMS 2026 public use files, 30 states). So the calculator never assumes a percentage: it uses yours. Our guide to how dental insurance works explains each class and term in more depth.

What the calculator leaves out

• How often the plan pays. Plans limit how often they pay for a procedure. GEHA’s 2026 Standard Option pays for an adult cleaning (D1110) twice a calendar year (p. 19), and its major (Class C) work is subject to a 5-year limitation (p. 25). A procedure past its limit is paid at zero. The tool has no box for that; ticking the waiting-period box gives the same sum (the plan pays nothing), though the tool will then name the waiting period as the reason.
• A second plan. With two dental plans, the second may pay part of what the first leaves. The GEHA and MetLife 2026 federal brochures work through examples with a federal health plan paying first. Run the calculator for the first plan only.
• Copay plans. Some plans charge a fixed dollar amount per procedure instead of a percentage; 30 of the 2026 HealthCare.gov stand-alone designs used a copay schedule for adult basic care. For those, your share is the copay in the plan’s schedule.
• Orthodontics. In the 2026 FEDVIP brochures, orthodontics has its own lifetime maximum, apart from the annual one. Use our braces and aligner payment calculator for those.
• Plan year. The plans in the table above run on the calendar year, and CareQuest says the plan year is typically a calendar year. If yours runs on a different benefit year, your summary of benefits says so.

The pre-treatment estimate decides

This calculator gives an estimate from what you type in. Your plan’s own estimate, sent before the work is done, is the better one: the dentist sends the treatment plan, and the plan replies with what it expects to cover and pay. Even that is not a promise. Delta Dental’s 2026 federal brochure calls it “non-binding” and “not a guarantee of payment” (p. 13). MetLife’s recommends one for any procedure expected to cost at least $300 and says actual payments may differ because of maximums, deductibles and frequency limits at the time of payment (p. 18). GEHA’s says its pre-determinations are valid through the calendar year in which they are prepared, or 12 months (p. 11). Ask how long yours is good for.

Your next step

• From the dentist’s office: a written treatment plan with each procedure on its own line, its code number and its fee, and a note of anything billed apart (X-rays, a core buildup, sedation, a lab fee).
• From your plan: a pre-treatment estimate; how much of this year’s maximum is left; whether a waiting period, a frequency limit, the missing tooth clause or a cheaper-alternative payment applies; and whether the dentist is in network on the date of treatment.
• Timing: if work can be split across two plan years, each year has its own maximum and deductible. Whether to split treatment, and how, is a question for your dentist.
• Paying your share: HSA and FSA money can pay qualified dental costs tax free; see dental expenses, HSAs, FSAs and taxes. Before you sign up for a medical credit card or loan, run the deferred-interest and dental loan calculator. If the bill is out of reach, our guide to free and low-cost dental care covers health centers with sliding fees and dental schools.

Sources checked on 11 November 2026: the 2026 FEDVIP dental brochures of GEHA, MetLife and Delta Dental (BENEFEDS copies), Delta Dental of Iowa’s 2027 individual policy, Cigna’s Dental 1000 summary (8/25) and Colorado contract extract (2025), CMS’s 2026 Marketplace public use files, HealthCare.gov, CareQuest Institute’s Maxed Out (February 2026), ADA News’s guide to dental benefit terms (2 June 2026), and the price pages named in the crown table and the filling example. Plan documents change each year; FEDVIP’s 2027 brochures follow its November-December 2026 open season.