Dental reimbursements concern several types of acts:

  • So-called preservative dental care  : scaling, caries treatment, devitalization …
  • The installation of a dental prosthesis  : crown, bridge, implant …
  • The consultation  : the dentist (or stomatologist) bills a consultation for appointments without care. This type of consultation simply includes diagnosis or control. The prices of consultations with the dentist are set by the Health Insurance. These non-care consultations are reimbursed at 70% on this basis.

CONSERVATIVE DENTAL CARE: RATE AND LEVEL OF REIMBURSEMENT

Conservative dental care is reimbursed up to 70% of the conventional social security tariff. Concerning the price level, like doctors, dentists can apply fee overruns (consultation and care).

Examples of treatments reimbursed at the conventional rate (source ameli.fr )

Dental care Conventional rate Repayment rate Amount reimbursed (1)
scaling 28,92 € 70% 20,24 €
Treatment of caries on one side 16,87 € 70% 11,80 €
Treatment of a two-sided decay 28,92 € 70% 20,24 €
Treatment of caries 3 faces and more 40,97 € 70% 28,67 €
De-vitalisation of an incisor or a canine 33,74 € 70% 23,61 €
Devitalization of a premolar 48,20 € 70% 33,74 €
Degeneration of a molar 81,94 € 70% 57,35 €
Extraction of a milk tooth 16,72 € 70% 11,70 €
Extraction of a tooth 33,44 € 70% 23,40 €

(1): the amount of reimbursement for care does not take into account the lump-sum contribution of € 1 which may be withheld if dental prosthesis is performed by a stomatologist.

REIMBURSEMENT OF DENTAL CARE BY YOUR COMPLEMENTARY HEALTH

This reimbursement concerns the difference between the rate charged by the dentist and the amount of the reimbursement paid by the Health Insurance. The terms of reimbursement for conservative care vary according to the type of contract subscribed with your mutual. The same applies to any excess fees charged by your dentist.

These fee surcharges applied by your dentist can only be charged for conservative care in the following cases:

  • Particular requirement on your part, such as a consultation outside the usual dental office hours.
  • Care provided by a dental surgeon with a permanent passing right (DP).
  • Care provided by a medical stomatologist practicing in sector 2, said sector with free fees.

PRICES AND REIMBURSEMENT OF DENTAL PROSTHESES

Dental prostheses can be reimbursed by the Health Insurance. They are then taken care of at 70% but on the basis of prices often much lower than their actual price.

Unlike conservative dental care, the fee charged by the dentist for dentures is free. Only the dentist or doctor-stomatologist has to set his tariffs “with tact and measure” (very vague notion) and inform the patient of the price of the intervention beforehand and by means of a written estimate.

An estimate made by your dentist for the installation of a dental prosthesis must include:

  • The precise and detailed description of the treatment (consultation, care) envisaged and / or the materials used;
  • The amount of fees for treatment (consultation and care costs);
  • The amount of the reimbursement borne by the Health Insurance.

Examples of fares and reimbursements for dentures ( www.ameli.fr ) for information only:

Dental prosthesis Rebate Rate Repayment rate Amount reimbursed (1)
Crowned Free fees 107,50 € 70% 75,25 €
Inlay-core Free fees 122,55 € 70% 85,78 €
Inlay-core with key Free fees 144,05 € 70% 100,83 €
Braces Free fees 64,50 € 70% 45,15 €
Complete dental appliance Free fees 182,50 € 70% 127,75 €
Bridge of three elements Free fees 279,50 € 70% 195,65 €

(1): the amount of the reimbursement of dental prostheses does not take into account the lump sum contribution of € 1 deducted if the care is carried out by a dental surgeon.

For dental prostheses, it is according to the contract subscribed by the insured that the complementary health will ensure a more or monthly reimbursement. This refund corresponds to the difference between the rate charged by the dentist and the amount reimbursed by the Health Insurance.

That is to say  : for dental prostheses, it is rather rare for the health supplement to cover the full reimbursement of the difference between the price of the prosthesis and the agreed rate of the Health Insurance.

PRICE AND REIMBURSEMENT OF A CONSULTATION WITH THE DENTIST

The dental surgeon or the medical stomatologist applies the tariff of a simple consultation in the case of an appointment without an act of care. Clearly, this type of consultation concerns only diagnoses or acts of dental control. The prices of consultations with the dentist are set by the Health Insurance. Their reimbursement corresponds to 70% of the conventional tariff.

Rates and refund:

Practitioner consulted Rate Basis of refund Repayment rate Amount reimbursed
Dentist 23,00 € 23,00 € 70% 16,10 €
Dental surgeon specializing in dentofacial orthopedics (ODF) 23,00 € 23,00 € 70% 16,10 €
Doctor-stomatologist practicing in sector 1 28,00 € 28,00 € 70% € 18.60 (1)
Physician-stomatologist practicing in sector 2 Free fees 23,00 € 70% € 15.10 (1)

(1) The amount of the reimbursement shall take into account the fixed contribution of € 1 deducted from each consultation or care performed by a doctor (here the dentist), except for: persons under 18 years of age, pregnant women from 6 th month of pregnancy up to 12 days after delivery, the beneficiaries of the complementary CMU or state medical aid. The total amount of the flat fee is capped at € 50 per calendar year (from 1 st January to 31 December) and the beneficiary.

Please note: a one-time fee of € 1 does not apply to consultations or treatments performed by a dentist.

As with other types of acts, the difference between the dentist’s fee (care, consultation, overpayment of fees) and the amount of the Health Insurance reimbursement can be covered by your health supplement depending on the Conditions set out in your contract.

To know  : for consultations with the dentist, exceedances of fees can be invoiced only in the following cases:
  • Special requirement on your part, such as a consultation outside the usual schedules of your dentist’s office.
  • Consultation or care by a dental surgeon with a permanent passing right (DP).
  • Consultation or care by a physician-stomatologist practicing in sector 2, said sector with free fees.

Documentation …

  • Health Insurance Site: Reimbursements for dental care and prostheses
  • French Dental Association
  • National Order of Dental Surgeons: www.ordre-chirurgiens-dentistes.fr
  • I go to the dentist … Why? : This booklet, edited by the association Sparadrap, dedramatise the consultation with the dentist.
  • Joint press release CISS-60 Millions of consumers-Santéclair: ” Overpayment of fees, deductions, deductibles … Creation of the Citizen Observatory for the remains in charge of health”