Dental Care And Prostheses: Your Reimbursements

Consultations with the dentist, dental care and prosthesis, orthodontic treatments, management of agenesia … Update on the rate of these acts and on their assumption by the Health Insurance.

REFUNDING YOUR CONSULTATIONS

Consultations with a dental surgeon or a registered dental surgeon are covered by the Health Insurance and reimbursed at 70% on the basis of conventional rates. Fee overruns are possible in some cases.

Consultation Fees and Refunds

Practitioner consulted Rate Basis of refund Repayment rate Amount reimbursed*
Dentist 23,00 € 23,00 € 70% 16,10 €
Dental surgeon specialized in dento-facial orthopedic treatment (ODF) 23,00 € 23,00 € 70% 16,10 €
Stomatologist practicing in sector 1 28,00 € 28,00 € 70% € 18.60 (1)
Stomatologist practicing in sector 2 Free Fees 23,00 € 70% € 15.10 (1)

(1) The amount reimbursed reflects the flat fee of € 1 retained on each visit or procedure performed by a doctor, except for persons under 18 years, pregnant women from the 6 thmonth of pregnancy until 12 days after the birth, the beneficiaries of the supplementary CMU or the medical aid of the State. 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 that the € 1 flat-rate fee does not apply to consultations and acts performed by a dentist.

Fee Overruns

Consultations with a dental surgeon or a dental surgeon may be subject to a fee overrun in the following situations:

  • In the case of a special requirement on your part, such as, for example, consultation outside the usual practice hours;
  • Consult a dental surgeon who has a permanent passing right (DP);
  • You see a medical stomatologist who practices in sector 2, said area with free fees.

In each of these situations, your dentist or your stomatologist is required to set his fees “tactfully and sensibly” and to notify you in advance.

You will be reimbursed on the basis of the conventional tariff and not on the basis of the fees paid. In fact, over and above fees are never borne by the Health Insurance. They may be taken care of by your complementary health, if the contract that you have underwritten it foresees. Check with her.

Before going to the dentist, should your doctor be consulted first?

No, except for certain heavy surgical procedures, you can consult directly with a dentist or a stomatologist without consulting your doctor. You will be reimbursed normally.

REIMBURSEMENT OF YOUR DENTAL CARE

Dental care includes conservative care (scaling, decay treatment, devitalization, etc.) and surgical care (extraction, etc.).

They are covered by the Health Insurance if they appear on the list of reimbursable acts and services, and are reimbursed at 70% on the basis of conventional rates.

Fee overruns are possible in some cases.

Dental rates and reimbursements
Dental rates and refunds on permanent teeth of children under 13 years of age
Pricing and reimbursement of groove seals

Fee Overruns

Dental care may be overstated in the following situations:

  • In the case of a special requirement on your part, such as, for example, care outside the usual office hours;
  • Consult a dental surgeon who has a permanent passing right (DP);
  • You see a medical stomatologist who practices in sector 2, said area with free fees.

In each of these situations, your dentist or your stomatologist is required to set his fees “tactfully and sensibly” and to notify you in advance.

You will be reimbursed on the basis of the conventional tariff and not on the basis of the fees paid. In fact, over and above fees are never borne by the Health Insurance. They may be taken care of by your complementary health if the contract you have underwritten so provides. Check with her.

REIMBURSEMENT OF YOUR DENTAL PROSTHESES

Dental prostheses are covered by the Health Insurance if they appear on the list of reimbursable acts and services, and are reimbursed at 70% on the basis of so-called liability rates, often below their actual cost.

Unlike consultations and dental care, the price of dental prostheses is free. It should be noted, however, that the dental surgeon or the stomatologist is required to set his fees “with tact and measure” and to inform you in advance by means of a written estimate.

Rates and refunds of dental prostheses: some examples

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