Resin/Composite Fillings Cost-Share
Under the TDP program, basic restorative procedures (fillings) have a cost-share of 20
percent for the member with United Concordia paying the remaining 80 percent when the care is
received from a TDP network
provider. The most common materials used for fillings are amalgam
(silver) and composite resin (tooth-colored).
What is Covered?
Under the TDP, the covered benefit for posterior (back) fillings is amalgam (silver). If the dentist and member select resin for back teeth fillings, the member must pay the difference between what the silver fillings would have cost and how much the resin costs. Resin fillings are covered for anterior (front) teeth only.
For example, a family member needs a filling on a back tooth. The dentist places a silver filling
at the allowable reimbursement rate of $100. Under the TDP, United Concordia pays 80 percent or $80
cost-share and the member pays a 20 percent cost or $20 cost-share. If the dentist places a
resin filling on a posterior tooth at the member’s request and bills $140, United Concordia still
pays only $80 (the 80 percent cost-share for a silver filling). The member now pays $60
(the $20 cost for the silver filling and the additional $40 in billed charges).
Determining Your Filling Material
According to the American Dental
Association (ADA), both amalgam (silver) and resin materials
are safe and effective options for filling back teeth. Amalgam is an affordable, durable
material with a long history of safe and effective use, while the resin offers a more natural
appearance but with an increased cost. Determining what filling material is best for the member
should be based on discussions between the TDP dentist and member.
