When dental decay or damage goes beyond a simple filling but isn’t quite large enough for a crown, inlays and onlays offer a durable, tooth-conserving solution. In fact, bcbs covered dental inlays and onlays can help you restore strength and function without breaking the bank. In this guide, you’ll learn what these restorations are, how your Blue Cross Blue Shield plan kicks in, and what steps to take next.
By the end, you’ll know exactly how inlays and onlays fit into your restorative care options, what coverage to expect under BCBS, and how to minimize your out-of-pocket costs.
Understanding inlays and onlays
What are inlays?
Inlays are custom-made restorations that fit within the cusps (points) of a back tooth. They replace the middle portion of your chewing surface where decay or old fillings have worn away.
You’ll usually get an inlay when:
- A cavity is too large for a direct filling
- You need better margins (edges) than a standard filling
- You want stronger protection without covering the entire tooth
What are onlays?
Onlays extend slightly beyond the tooth’s cusps to cover one or more chewing surfaces. Think of them as a halfway point between an inlay and a full crown.
Onlays are a smart pick when:
- You have a weakened cusp after root canal treatment
- A filling has repeatedly chipped or leaked
- You want to conserve natural tooth structure
Materials and process
Gold alloys
Gold inlays and onlays have been used for decades thanks to their strength and biocompatibility. They require minimal wear over time but are more noticeable in your smile.
Ceramic and porcelain
Tooth-colored ceramics match natural enamel and resist staining. Lab-fabricated porcelain inlays/onlays deliver excellent esthetics and seal tightly against decay.
Composite resin
Composite restorations can be directly fabricated in the mouth or pre-made in a lab. They’re affordable and blend in well, but may not last as long under heavy chewing forces.
Zirconia restorations
Zirconia combines the toughness of metal with the look of ceramic. It’s ideal for back teeth that endure high biting pressures and offers excellent longevity.
Indications and contraindications
Inlays and onlays shine when you need moderate repair without a full crown. You’re a great candidate if you:
- Have a cavity too big for a filling but too small for a crown
- Want to preserve more of your natural tooth
- Can sit through two appointments (one for impressions, one for bonding)
They’re less suitable if you:
- Clench or grind teeth heavily (bruxism)
- Have very shallow preparations or extremely limited space
- Can’t tolerate impression taking (though digital scans may help)
Exploring BCBS plan coverage
Plan levels and categories
Blue Cross Blue Shield FEP Dental and many BCBS plans group services into tiers:
- Basic services (exams, cleanings, sealants)
- Intermediate services (fillings, simple extractions)
- Major services (crowns, bridges, root canals)
Most plans treat inlays and onlays as major restorative services. Here’s what you can generally expect: after meeting your annual deductible, BCBS covers roughly 50% of major services. If you’ve opted for a High Option plan, intermediate services may be covered at 80%, but major service coverage often remains around 50%.
In-network versus out-of-network
Choosing an in-network dentist usually lowers your costs. BCBS FEP Dental has over half a million in-network providers nationwide, and 99.9% of members have at least one within 15 miles. You can easily find an in-network specialist by searching online or calling member services, then booking with a restorative dentist accepting bcbs insurance.
Going out-of-network gives you freedom to pick any licensed dentist, but you’ll pay a separate deductible (around $75 per person on Standard Option, $50 on High Option) plus higher coinsurance rates.
Highlighting benefits for seniors
Protecting tooth structure
Inlays and onlays conserve more natural tooth than crowns, which require reshaping the entire outer surface. For seniors, preserving sturdy enamel means less risk of sensitivity and future decay.
Longevity and esthetics
Custom-fit restorations resist occlusal (chewing) forces better than direct fillings. They can last 10 to 30 years with proper care, so you face fewer replacements down the road. Plus, tooth-colored inlays/onlays blend seamlessly with your smile.
If you ever need a different fix—say a full-coverage crown—your BCBS plan also covers those under major services. Check your details for bcbs covered dental crown and bridge.
Estimating your out-of-pocket costs
Typical cost ranges
Actual prices vary by material, location, and practitioner. Here’s a ballpark for one tooth:
| Material type | Average cost per tooth | BCBS in-network coverage | Estimated your share after coverage |
|---|---|---|---|
| Gold inlay/onlay | $650 – $1,200 | ~50% | $325 – $600 |
| Porcelain/composite | $700 – $1,500 | ~50% | $350 – $750 |
| Zirconia restoration | $800 – $1,600 | ~50% | $400 – $800 |
If you have a High Option plan that covers intermediate restorations at 80%, your share could drop to $140–$300 for porcelain inlays classified as intermediate.
Deductibles and coinsurance
Before BCBS starts paying, you’ll meet your annual deductible—often $50 or $75 for out-of-network care. After that, you pay coinsurance, typically:
- 20% on basic and intermediate services (High Option)
- 50% on major services (both Standard and High Option)
Always confirm your exact percentages in your plan booklet or on the BCBS member portal.
Starting your dental journey
Finding the right dentist
Begin by verifying in-network status online or with a quick phone call. Many general and restorative dentists offer inlays and onlays, but look for someone with a track record in indirect restorations.
If you think you might need implants later on, you can also explore your coverage for that under bcbs covered dental implant restoration.
Preparing for your visit
On your first appointment, expect:
- A thorough exam and X-rays
- Tooth preparation and detailed impressions (or digital scans)
- Placement of a sturdy temporary restoration
Digital impression systems (for example CEREC or 3M Lava) speed up the process and avoid messy putty.
Filing claims and follow-up
Most claims must be filed within two years of service. Keep your receipts and procedure codes handy. You can:
- Upload documentation via the BCBS member portal
- Call customer service to check claim status
- Schedule a follow-up visit for final bonding
Review key takeaways
- Inlays and onlays bridge the gap between fillings and crowns, conserving tooth structure while boosting strength.
- Most BCBS plans classify these as major services, covering about 50% after deductible.
- Choosing an in-network provider keeps coinsurance and deductibles lower.
- Materials range from gold to zirconia—pick what fits your needs and smile goals.
- Plan ahead: confirm coverage details, find your dentist, and track claim deadlines.
Ready to restore a damaged tooth with BCBS-covered inlays or onlays? Call your dentist’s office today or log in to your Blue Cross Blue Shield portal to review benefits. If you have questions or personal tips, share them in the comments below so everyone can smile a little brighter.
