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What dental care does the statutory health insurance company pay for in Germany?

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What dental costs are covered by insurance in Germany? Which checkups are treatments can I get for FREE?

Some dental services such as professional teeth cleaning are a private service in Germany. But the statutory health insurance companies pay for checkups for children, adolescents and adults. Find out how dentistry and dental care in Germany works below.

dental care

Overview of dental coverage in Germany

  • Since July 1, 2019, statutory dental care has already started for children from the age of 6 months. This means that children up to the age of 6 are entitled to six screening examinations.
  • Since May 2015, the pediatrician has been documenting a reference to the dentist from the age of 6 months in the yellow children’s examination booklet, from U5 to U9
  • For adults, the check-up is free twice a year, the tartar removal once a year and the early detection of periodontal disease every two years.
  • Many health insurances voluntarily offer subsidies for professional teeth cleaning as a statutory benefit.

Because professional teeth cleaning is a private service, many patients assume that the statutory health insurance companies do not pay for dental prophylaxis, i.e. disease prevention, in any other way. However, that is not true. There are many offers for children and young people, and adults can also take advantage of pension benefits.

Does my statutory health insurance cover dental care for adults?

Adults who have statutory health insurance can go to the dentist for a check-up free of charge once every six months. Tartar removal is covered by the health insurance fund once a year, and a periodontal screening index (PSI) is drawn up every two years. Insured persons have a statutory right to these three benefits.

The aim of the check-up is to identify diseases early and to initiate further treatments if necessary. The dentist examines all the teeth in turn. A dental chart records which teeth are missing, which are filled, crowned or replaced. In addition, the dentist pays attention to the oral mucosa, gum pockets, discoloration, tartar and changes to the tongue. It is advisable to have these preventive examinations entered in the bonus booklet in order to receive a higher fixed subsidy from the health insurance company in the event that dental prostheses are required at a later date.

The removal of tartar makes sense because plaque irritates the gums and leads to inflammation. Inflammation of the gums (gingivitis) can develop into an inflammation of the periodontium (periodontitis).

The periodontal screening index has been a health insurance benefit since 2004. The dentist uses a small special probe to measure gum pockets in the upper and lower jaw. This procedure allows a rough assessment of whether periodontitis that requires treatment is present.

Definition of the KIG classification

  • KIG 1 – the diagnosis is a light tooth misalignment. There is no medical necessity for a treatment. The health insurance does not participate in this case.
  • KIG 2 – the diagnosis is a malocclusion with the necessity of a medial treatment but the tooth correction is not subsidized by the medical insurance.
  • KIG 3 – the diagnosis is a pronounced malposition which needs to be treated.
  • KIG 4 – the diagnosis is a very pronounced malposition. From the medical point of view the treatment is an urgent request.
  • KIG 5 – in this classification the patient suffers from a massive tooth misalignment. From the medical perspective an orthodontic therapy is indispensable
dental care

What kind of dental care provisions are there for children?

New statutory benefits for the prevention of tooth decay in small children have been in effect since July 1st, 2019. According to this, children between the ages of 6 and 34 months are entitled to three additional early diagnosis examinations. These are timed to match the U-examinations.

Between the ages of 3 and 6, the statutory health insurance companies take over the three usual dental screening examinations. Since July 1st, 2019, children up to the age of 6 have the right to a total of six preventive medical checkups.

From 6 to 18 years of age, there are half-yearly check-ups as well as the fissure sealing of the two permanent molars in front of the wisdom teeth. In addition, small children up to the age of 33 months are entitled to enamel hardening with fluoride varnish twice every six months. There is also group prophylaxis for kindergarten children and school children up to and including eleven years of age. Here the children practice how to brush their teeth properly under professional guidance, receive nutritional advice and should be motivated to practice correct oral hygiene at home.

Are there any additional dental care health insurance benefits?

Many statutory health insurance companies cover all or part of the costs for professional teeth cleaning. However, in what amount and under what conditions is very different. Such offers are voluntary statutory benefits that each health insurance company can decide independently.


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All dental health insurance benefits at a glance

  • Despite many restrictions, there are many services, from tartar removal to orthodontics, that are partially or fully paid for by statutory health insurances.
  • The statutory health insurance companies pay for what is medically necessary. Additional offers that are subject to a fee often only contain an aesthetic added value and less an additional medical benefit.
  • Some health insurance benefits must be applied for in writing from the health insurance company before the start of treatment.
Dental care service Statutory insurance coverage
Dental care
For adults, statutory health insurances pay for
• 2 dental check-ups per year
• 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
• 2 dental check-ups are paid for as well as a caries-prophylactic filling of tooth furrows (fissure sealing) of the two permanent molars in front of the wisdom teeth


For children between the ages of 3 and 6
• the statutory health insurance companies take on 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


For children between the ages of 6 and 34 months
• They 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
• There is also a right to fluoridation to harden tooth enamel twice every six months
Dental fillings
• The statutory health insurances reimburse so-called composite fillings made of tooth-colored plastic in the anterior region (incisors and canines)
• 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, an additional cost agreement will be concluded
• In the case 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
Root canal treatments
The scope of services provided by the health insurance company includes
• Root 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.


For the rear posterior teeth, a root canal treatment is covered by the health insurance if a closed row of teeth can be obtained, if the treatment prevents a row of teeth from being shortened backwards on one side or if an existing denture can be retained. The details are regulated in the guidelines of the Federal Joint Committee for Contract Dental Care.


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.
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 4.0 mm or more
• A written application must be submitted to the health insurance company before the start of treatment. For this purpose, the dentist creates a treatment and cost plan that the patient submits to the health insurance company for review and approval


Until now, those affected by periodontitis had to pay for the pre- and post-treatment themselves. That is now different, because since July 1, 2021, the statutory health insurances have not only taken over the acute treatment for a diagnosed periodontal disease, but also an extensive aftercare, which also includes the cleaning of all teeth.


In future, insured persons will be able to take advantage of follow-up care (called “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.
Treatment of misaligned teeth (orthodontics)
In children up to the age of 18, orthodontists check the severity of the malocclusion using five orthodontic indication groups, or KIG for short.

• From KIG, 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 these are reimbursed after the treatment is completed. If two or more children are receiving orthodontic treatment at the same time, the parents only have to pay 10% in advance.
Dentures
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 pay 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.
dental care

There are 11 groups of medical causes of malpositioned teeth or jaw:

  • tooth eruption disturbances
  • developmental disturbances in the head area
  • undershot bites (hypodontie)
  • distal bite position of the teeth (due to recession of the lower jaw)
  • mesial bite position (due to protrusion of the lower jaw – progenia)
  • open bite
  • deep bite
  • buccal occlusion or lingual occlusion (bilateral cross-bite)
  • deviation of the jaw widths (end to end bite)
  • deviation of the contact points (close proximity of the teeth)
  • lack of space

Dental examination costs in Germany

An examination at the dentist is billed according to the type of examination, the reason for the examination and the type of insurance of the patient according to different items or fee numbers and fee schedules. Dental examinations therefore cost different amounts “naturally”.

We have then compiled a few of these positions for you as examples. Please note that these are essentially orientational basic examinations. In-depth examinations (such as x-rays or vitality tests of the teeth) each have their own position and their own fee rate.

1. According to the fee schedule for dentists GOZ

The fee schedule for dentists (GOZ – Gebührenordnung für Zahnärzte) is used, if possible, to calculate the dentist’s costs (or to bill the dental service) for all private patients and for those statutory health insurance patients who make use of a private service.

The GOZ or Gebührenordnung für Zahnärzte (fee schedule for dentists) determines the remuneration for dental services for privately insured persons. In addition, it regulates the billing amount for the portion of treatments that have to be taken over by the statutory health insurance patients themselves. The amended schedule of fees for dentists has been in effect since January 1st, 2012.

DescriptionDetailed check up
Fee catalogGOZ 0010
score100
number1
Costs: Easy set€ 5.62
Costs after: 2,3 times per sentence€ 12.94
Costs after: 3,5 times per sentence€ 19.68

2. According to the fee schedule for doctors GOÄ

If a dental service is not included in the GOZ or in the BEMA, the dentist can use the fee schedule for doctors (GOÄ) to calculate the dentist costs.

The GOÄ or Gebührenordnung für Ärzte (Schedule of Fees for Doctors) forms the basis for calculating and billing the remuneration for medical services that are not covered by social insurance. The fee schedule for medical services is attached to the GOÄ as an annex. According to GOÄ, the doctor is entitled to fees, compensation (travel allowance, travel allowance) and reimbursement of expenses as remuneration.

DescriptionAdvice – also by telephoneSymptomatic investigation
Fee catalogGOÄ 1GOÄ 5
score8080
number11
Costs: Easy set€ 4.66€ 4.66
Costs after: 2,3 times. Sentence€ 10.72€ 10.72
Costs after: 3, 5 times. sentence€ 16.31€ 16.31

3. According to the assessment standard for dental services (BEMA)

The Bewertungsmaßstab zahnärztlicher Leistungen (BEMA) is used to calculate the dentist-cost (or to the billing of dental power) for all statutory insurance patients taking into account what they are entitled to according to the statutory insurance.

The BEMA or Bewertungsmaßstab zahnärztlicher Leistungen (uniform evaluation standard for dental services serves as the basis for billing treatments in dental practices with the statutory health insurance (GKV).

DescriptionDetailed check upOrthodontic Exam
Fee catalogBEMA 01BEMA 01k
score18th28
number11
costs16.92 €€ 84.36

What is the difference between private and public health insurance for dental care in Germany?

Private health insurance also covers more expensive treatments that go beyond standard care. In addition, privately insured people usually have to pay less for their treatment. However, this depends heavily on the insurance company in question. Low-cost providers may only offer very rudimentary protection. In addition, the private health insurance does not make its reimbursement of costs dependent on the regular preventive examinations, as documented in the bonus booklet.

Statutory health insurancePrivate health insurance
Dentist costsImplant: 2100 €Crown: 500 €Total: 2600 €Implant: 2100 €Crown: 500 €Total: 2600 €
Share of health insuranceImplant: 0 € (0%)Crown: 325 € (65%)Total: 325 €Implant: 1575 € (75%)Crown: 375 € (75%)Total: 1950 €
Deductible2275 €€ 650
Table Info: Costs and deductibles for replacing a missing tooth with an implant (implant + crown) with private health insurance (75% cost coverage) and statutory health insurance (10-year bonus booklet, 75% of standard care) in comparison:

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