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Oral Surgery

Oral surgery refers to surgical procedures performed in or around the mouth and jaw by a licensed dentist, oral surgeon, or maxillofacial specialist. It includes both minor procedures, such as tooth extractions, and more complex surgeries involving the jawbone, soft tissue, or dental implants.

Health and dental insurance plans categorize oral surgery differently depending on where it is performed and the reason for treatment. Routine extractions and minor surgical procedures are usually covered under dental benefits, while more extensive operations related to injury, disease, or medical necessity may be covered under extended health benefits.

Oral surgery benefits typically include reimbursement for services such as wisdom tooth removal, treatment of oral cysts, repair of jaw fractures, and certain gum or bone surgeries. Some procedures may require pre-authorization, especially if they are performed in a hospital or under general anesthesia.

Example:

If your dental plan covers 80 percent of basic and surgical extractions, and the removal of impacted wisdom teeth costs $600, your plan pays $480 and you pay $120.

What to Watch For:

Check whether your plan classifies oral surgery as a dental or medical expense, since this affects which benefit pays first. Hospital-based oral surgery may require a referral and pre-approval. Always confirm whether anesthesia, facility fees, and follow-up care are included under your benefit.

Related Terms

Occupational Class

Occupational class is the category assigned to an individual based on the type of work they perform and the level of risk associated with their job. Insurers use occupational classes to help determine eligibility, premium rates, and benefit levels for life, disability, and accident insurance. The classification reflects how likely a person is to experience injury, illness, or death related to their occupation.

Optional Benefit / Rider / Add-On

An optional benefit, also called a rider or add-on, is an additional feature that can be purchased to enhance your existing health, dental, life, or disability insurance plan. Optional benefits allow you to customize coverage by adding protection that suits your personal needs, rather than relying only on the base plan design.

Orthodontics

Orthodontics covers the cost of correcting tooth alignment and jaw positioning using braces or aligners. In individual and group dental plans, orthodontic benefits are usually separate from preventive and restorative coverage. Most plans apply a lifetime maximum and a waiting period before orthodontic treatment is eligible.

Orthopedic Shoes / Custom Orthotics

Orthopedic shoes and custom orthotics are specialized footwear and inserts designed to support proper alignment, relieve pain, and improve mobility for individuals with foot, leg, or posture-related conditions. These items are often prescribed to correct biomechanical issues, provide additional cushioning, or accommodate deformities caused by medical conditions such as arthritis, diabetes, or plantar fasciitis.

Overall Plan Maximum

An overall plan maximum is the total amount your health and dental plan will pay for all combined benefits within a single policy year. Once the limit is reached, you must pay any additional expenses out of pocket until the next renewal period.

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