How Health Insurance Works FOR DENTAL SURGERY (Hospital vs Extras Explained)
- Dr Andrew Chan
- 19 hours ago
- 5 min read
Trying to understand what your private health insurance actually covers for dental treatment, wisdom teeth, teeth extractions, dental implants, All-on-4 implant bridges, and implant-supported dentures is confusing.
Most Australians might know they have private health insurance. But most will not know what they are actually covered for, especially when it comes time for dental treatment, dental surgery or oral surgery.
This guide explains how health insurance works in Australia specifically in relation to dental treatment, dental surgery, wisdom teeth, tooth extractions, dental implants, All-on-4 dental implants, and implant-supported dentures.
The Two Parts of Private Health Insurance in Australia
Private health insurance is made up of two different types of health insurance:
Hospital Cover
Extras Cover (General Treatment / Ancillary Cover)
They do very different things, and for many dental and oral surgery procedures, both can apply at the same time.
What Hospital Cover Pays For in relation to Wisdom Teeth and Dental Implants
Hospital insurance covers you when you are admitted as a private patient into:
A private day surgery
A private hospital in
Hospital cover typically pays for:
Day surgery / hospital theatre fees
Anaesthetist fees (partially or fully depending on policy)
Medications used during your admission
Materials, and components used in your susrgery (depending on you policy)
Accommodation if required
At Adelaide Tooth Removals & Dental Implants, the following procedures are commonly performed under general anaesthetic in a Day Surgery or Private Hospital. And Hospital Insurance will apply.
Complex surgical teeth extractions
Full mouth extractions
Dental implant surgery
All-on-4 / All-on-X implant bridge surgery
Hospital insurance cover only 'activates' if these procedures are performed in a Day Surgery or Private Hospital. In these cases, your hospital cover is paying for the Day Surgery / Private Hospital fees and your anaesthetic fees, not your extras.
If these procedures are performed in our dental practice, your hospital insurance is not 'activated' and does not cover any costs. Your Extras Insurance might, however.
What Hospital Cover Pays For Beyond Dental
Hospital cover is designed mostly for non-dental, medical or surgical issues. It’s main purpose is to cover you whenever you’re admitted as a private patient to a private hospital or day surgery for medical treatment.
In general, hospital cover contributes to the facility and medical costs associated with being admitted for procedures such as:
Orthopaedic surgery (e.g. knee or shoulder surgery)
General surgery (e.g. gallbladder, hernia, appendix)
Gynaecological procedures
Urological procedures
ENT surgery
Cardiac procedures
Gastrointestinal endoscopy and colonoscopy
Obstetrics (for policies that include pregnancy)
Plastic and reconstructive surgery (where medically indicated)
Cancer
Major trauma
Major illnesses
When you are admitted, hospital cover typically helps pay for:
Operating theatre fees
Hospital accommodation (same-day or overnight)
Nursing care
Equipment and sterilisation
Recovery room care
Some or all of the anaesthetist and specialist fees (depending on your policy and gap arrangements)
Exactly what is covered depends on your policy tier (Basic, Bronze, Silver, Gold) and any clinical categories included, but the key concept is this:
Hospital cover pays for the costs of being treated inside a hospital as an admitted patient — regardless of whether the treatment is dental, medical, or surgical.
What Extras Cover Is - And It’s Not Just Dental
Extras cover helps pay for treatment outside of a Day Surgery or Private Hospital and includes much more than dental.
Extras often contribute toward:
Dental treatment
Optical (glasses and contacts)
Physiotherapy
Chiropractic
Osteopathy
Podiatry
Psychology
Remedial massage
Dietetics
Speech therapy
So when people say “I have extras,” dental is only one part of what they’re paying for.
How Extras Cover Applies to Dental Surgery, Wisdom Teeth, Tooth Extractions, Dental Implants & Dentures
Extras may contribute toward:
Procedure | Usually Covered by Extras? |
Wisdom teeth removal | Yes |
Tooth extractions | Yes |
Dental implants | Sometimes (higher policies) |
All-on-4 implant bridges | Sometimes (major dental limits) |
Implant-supported dentures | Sometimes |
Dentures | Yes |
General Dental (ie fillings, checkups, root canals, crowns, cleans) | Yes |
However, extras cover has:
Annual limits
Waiting periods
Percentage rebates
Separate major dental caps
For wisdom teeth, tooth extractions, dental implants, All-on-4 implant bridges, and implant-supported dentures in Adelaide, extras usually only cover a portion due to these caps.
Why Your Rebate Is Difficult to Predict
Every fund, every policy and every level of cover is different. Two patients with the same fund can get very different rebates.
The only way to know is to:
Get item numbers from your dentist
Call your insurer (or get your dentist to swipe your insurance card)
Note:
They will not quote without item numbers.
They will not allow the dentist or dental practice staff to call on your behalf.
Dental Surgery Item Numbers
A dental item number is a standard code from the Australian Dental Association (ADA) Schedule that describes exactly what treatment was performed. Think of it like a universal label for a procedure.
For example:
011 — Comprehensive oral examination
022 — Intraoral periapical X-ray
037 — Orthopantomogram (OPG panoramic X-ray)
311 — Uncomplicated tooth extraction
314 — Removal of tooth or tooth fragments
322 — Removal of impacted tooth (soft tissue impaction)
324 — Removal of impacted tooth (full bony impaction)
684 — Placement of dental implant fixture
These numbers are used by:
Dentists when preparing treatment plans and invoices
Health insurance funds when calculating your rebate
Patients when calling their insurer to ask, “What will I get back?”
Your health fund does not work off descriptions like “wisdom teeth removal” or “implant.” They work off item numbers.
That’s why, before treatment for wisdom teeth, teeth extractions, dental implants, All-on-4 implant bridges, or implant supported dentures, you should ask your dentist for a treatment plan with item numbers — so your insurer can give you an accurate rebate quote.
Template: Calculate Your Out-of-Pocket Costs
Use this when you call your insurer about wisdom teeth removal, teeth extractions, dental implants, All-on-4 implant bridges, or implant-supported dentures in Adelaide.
Blank Template
Item Description | Item Number | Insurance Rebate | Fee | Out Of Pocket Cost |
Day Surgery Fees | - | |||
Anaesthetic Fees | - | |||
Insurance Hospital Excess | - | |||
Total Out Of Pocket Costs |
Example (Wisdom Teeth Removal in Day Surgery)
Item Description | Item Number | Insurance Rebate | Fee | Out Of Pocket Cost |
Impacted wisdom tooth (full bony impaction) | 324 | $250 | $690 | $450 |
Impacted wisdom tooth (full bony impaction) | 324 | $250 | $690 | $450 |
Impacted wisdom tooth (soft tissue impaction) | 322 | $200 | $470 | $270 |
Impacted wisdom tooth (soft tissue impaction) | 322 | $200 | $470 | $270 |
Day Surgery Fees | - | $1,200 | $1,200 | $0 |
Anaesthetic Fees | - | $900 | $1,100 | $200 |
Hospital Insurance Excess | - | - | $500 | $500 |
Total Out Of Pocket Costs | $2,140 |
(Example only — your rebate depends entirely on your policy.)
The Key Takeaways for Patients in Adelaide
Hospital cover helps pay for Day Surgery / Private Hospital fees and Anaesthetic fees for wisdom teeth, extractions, implants and All-on-4 procedures.
Extras cover contributes to the dental treatment and also covers optical, physio and allied health.
Large procedures like dental implants, All-on-4 implant bridges and implant supported dentures in Adelaide often use both.
Your dentist cannot predict your rebate.
Accurately calculating your private health insurance rebates and out-of-pocket costs is annoying, time-consuming and confusing
You must call your insurer with item numbers.
Using the table above can help you calculate your true out-of-pocket cost before treatment.
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