Health care Dental services: what do health insurance providers cover?

Statutory health insurance providers cover the cost of medically necessary treatments and examinations performed in dental practices. Special regulations from the Joint Federal Committee (Gemeinsamer Bundesausschuss – G‑BA) establish which dental services are covered. These include but are not limited to the following:

• Check-ups
• Cavity fillings
• Root canal treatment
• Periodontitis treatment
• Dental prostheses (costs covered up to the amount of the legally established subsidies)
• Orthodontic treatment for children and adolescents (also for adults in the case of certain serious jaw abnormalities)

Health insurance providers cover dentistry costs as non-cash benefits. This means that the dental practice settles the costs with the health insurance provider directly. Insurance holders do not have to pay for services up front. This is subject to the prerequisite that the dentist has been authorized to provide care to people with statutory health insurance. 

Preventive services are used to detect and treat dental and gum diseases at an early stage. Statutory health insurance providers therefore cover the cost of certain dental check-ups and preventive measures. 

Preventive services for adults

For adults, health insurance providers cover the cost of a dental check-up once every six months. They also cover the cost of tartar removal once a year and periodontitis screening every 2 years. 

People with disabilities or who have been assigned a care grade can receive additional services for the prevention of dental diseases.

Preventive care for children

The costs of dental check-ups for children are covered from the age of 6 months. Children should receive 3 check-ups by the age of 3. These are coordinated to time with the U check-ups by a pediatrician. Up to the age of 6, children are also entitled to have their enamel hardened with fluoride varnish twice every 6 months. 

Between the ages of 3 and 6, health insurance providers also pay for 3 further check-ups at 12‑month intervals. After this, statutory health insurance covers the costs of check-ups twice a year. 

In children with vulnerable teeth, the sealing of the first permanent molars is also a standard service covered by health insurance providers.

An overview of the individual elements of dental check-ups for the different age groups can be found on the website of the Federal Ministry of Health (Bundesministerium für Gesundheit – BMG). 

In the case of caries treatment, health insurance providers cover the costs of a filling. Dental amalgam has been prohibited in the EU since January 1, 2025. As a result, dental practices no longer use amalgam for new cavity fillings. The costs of molar fillings using self-adhesive materials are generally covered. Such materials are usually in the form of glass ionomer cements although bulk fill composites can also be used on exceptions. For the incisors and canines, the costs of fillings using tooth-colored composite are covered. People who want a different type of filling must cover the additional costs themselves. 

Health insurance providers also pay for root canal treatments and the treatment of periodontitis. Extensive periodontitis treatment must be applied for to the health insurance provider in advance and approved. The dentist takes care of this approval. If extensive periodontitis treatment has been approved, the aftercare costs are also covered. 

If teeth are missing or so badly damaged that fillings are no longer an option, dental prostheses are required. These include crowns, bridges and removable dentures. Special rules apply to cost assumption in this service area:

Health insurance providers will pay a fixed subsidy toward the costs of “standard care”. This means the medical services required due to a particular finding. The Federal Joint Committee (Gemeinsamer Bundesausschuss – G‑BA) stipulates which services these are in its regulation on fixed subsidies (Festzuschuss-Richtlinie). The amount of the fixed subsidy is equivalent to 60 percent of the average cost of standard care. If patients have a bonus booklet that enables them to prove that they have received annual dental check-ups for 5 years, the subsidy rises to 70 percent of the cost of standard care. After ten years, the subsidy rises to 75 percent. Patients must cover any further costs themselves. 

The receipt of a fixed subsidy for dental prostheses from a health insurance provider is subject to the patient having a “treatment and cost plan”. The dentist uses this to record details of the damage to the teeth, which teeth are missing and what standard care options there are. The treatment that is actually planned is also entered. Statutory health insurance services and private supplementary services, as well as the expected costs, are recorded separately. Patients receive a printed summary that outlines the planned treatment and expected costs. If they have consented to this, the dental practice will digitally transmit the treatment and cost plan to the health insurance provider. The health insurance provider must approve the plan prior to treatment taking place. 

Once it has reviewed the treatment and cost plan, the health insurance provider will specify the precise proportion of the costs that it will cover. This is known as the fixed subsidy. Once the health insurance provider has approved the plan, the patient must receive the dental prostheses within six months. If this is not the case, the dentist must apply for an extension to the treatment and cost plan. 

What additional costs do I incur?

The annex to the treatment and cost plan lists all services that you have to pay for yourself. These are known as private services. Typical private services include the veneering of metal crowns or the choice of a ceramic crown. Dentists can offer these services in addition to standard care. The cost of private services is settled in line with the private fee schedule for dentists. 

In most cases, dental implants must also be financed privately. The costs are only covered by health insurance providers in very few, particularly serious cases.

In the case of extremely expensive treatments, it can be worth obtaining a second dental opinion. This is because the suggested treatment methods and associated costs can differ from dentist to dentist.

You can therefore ask a second dentist of your choice for a further treatment and cost plan. You can also use the free second opinion service for patient advice provided by the Associations of Statutory Health Insurance Dentists (Kassenzahnärztliche Vereinigungen – KZV). Various web portals also offer a second opinion service but these are not all free of charge.

Information about the second opinion service offered by the KZV can be found on the National Association of Statutory Health Insurance Dentists (Kassenzahnärztliche Bundesvereinigung) website.

Private supplementary insurance fully or partly covers the private costs of dental prostheses. The specific private tariffs depend on a patient’s age and health as well as the desired services. It is advisable to compare the services and prices offered by various providers before concluding a supplementary insurance contract. Patients with supplementary insurance should notify the provider about the planned treatment and estimated costs prior to the start of the treatment.

A 2-year statutory guarantee period applies to dental prostheses. This means that if defective dental prostheses cause problems, the dentist must repair or replace them free of charge within the first 2 years. However, this entitlement only applies to people with statutory insurance and not those with private insurance. It also only applies if the patient is not responsible for causing the defect to the dental prostheses. 

What support is available for people with a low income?

If a patient receives social benefits or has a gross monthly income that is below a certain threshold, health insurance providers will cover the full costs for standard care. This is referred to as hardship regulations. People whose income lies just above the hardship threshold are not entitled to full cost assumption. However, the percentage covered by health insurance providers is then calculated on a case-by-case basis.

Further information on the hardship regulations can be found on the Consumer Advice Center (Verbraucherzentrale) website.

Statutory health insurance providers generally only cover the cost of orthodontic treatment for children and adolescents. The severity of the misalignment of the teeth or jaw determines the level of cost assumption. The orthodontic specialist assesses the misalignment on the basis of 5 levels of severity. These are known as orthodontic indication groups (KIG – from the German “Kieferorthopädische Indikationsgruppen”).

Health insurance providers cover the costs of standard care from KIG 3 as long as the patient is aged between 10 and 18 at the start of treatment. On exceptions, younger children can also receive orthodontic treatment. Any services that go beyond standard care services must be paid for privately. This is the case, for example, if a patient wants braces made from particular materials or in a particular color. 

The orthodontist must create a treatment plan with a cost breakdown prior to starting the treatment. This treatment and cost plan shows which costs will be borne by the health insurance provider and which costs have to be paid privately. The treatment and cost plan must be submitted to and approved by the health insurance provider prior to the start of treatment.

As orthodontic treatment can be expensive, it is worth checking the treatment and cost plan very carefully. In the event of any doubt, a second opinion should be obtained. There are many ways to correct misaligned teeth, some of which are more complicated and expensive than others. Random testing by Stiftung Warentest has shown that there can be major differences in the treatment suggestions, prices and performances of individual practices. 

Health insurance providers only cover the costs for adults on exceptions in the event of certain serious jaw abnormalities.

For adults with a night-time breathing disorder (obstructive sleep apnea), health insurance providers cover the costs of a lower jaw protrusion splint. However, this only applies if it has not been possible to improve the condition through the use of continuous positive airway pressure with a respiratory mask. 

Professional tooth cleaning is not classed as standard care covered by statutory health insurance providers. However, some health insurance providers fully or partly refund the cost of tooth cleaning within the scope of their voluntary supplementary services.

Your health insurance provider can inform you about partial cost assumption, refunds and bonus programs. Health insurance providers are also a good point of contact if you have questions about a treatment and cost plan.

Details of the dental services to which everyone with statutory insurance is entitled can be found in the regulations from the Joint Federal Committee (Gemeinsamer Bundesausschuss – G‑BA).

The Consumer Advice Centers explain what the treatment and cost plan includes and how it is structured.

Further information about dental services can be found on the Consumer Advice Center portal.

Personal advice on issues related to healthcare and healthcare legislation can be obtained, among other places, from the Independent Patient Advice Service for Germany (Stiftung Unabhängige Patientenberatung Deutschland – UPD).

You can also obtain advice on topics relating to healthcare legislation from several Consumer Advice Centers.