Estimate what an extras policy that pays a percentage of the fee would refund on a dental bill, and your gap.
Many extras policies pay a percentage of the dentist's fee on each item, up to an annual limit for that service type (for example general dental, or major dental). This calculator applies the percentage to the fee and shows your gap.
Formula: benefit = fee × benefit %; gap = fee − benefit.
Then check the limit yourself. If the benefit is higher than what remains of your annual limit for that category, the fund pays only the remaining limit and your gap grows by the difference. Some funds pay a fixed dollar amount per item number instead of a percentage, or a fixed percentage only up to a per-item maximum; in that case ask the fund for the benefit on each item number and add them up.
Worked example (illustrative): a $2,400 crown and root canal on a policy paying 50% gives a $1,200 benefit and a $1,200 gap. If only $800 of the major dental limit is left this year, the fund pays $800 and your gap is $2,400 − $800 = $1,600.
Limits: waiting periods, sub-limits, lifetime limits and exclusions (many policies exclude implants or cap them tightly) are not modelled. Get a written quote with item numbers and ask your fund for a benefit quote before treatment. See extras cover for major dental and implants.
Worked estimates and checklists
An illustrative Australian estimate for root canal treatment followed by a crown on a molar, general dentist versus endodontist, with extras benefits and the extraction-and-implant comparison.
Costs, price factors and 2026 schemes
How Australian extras policies treat implants, crowns and dentures under major dental, the waiting periods and limits that apply, and how to get a benefit quote first.
When things go wrong, and official sources
Why extras dental claims are reduced or refused in Australia, how to check the benefit, and how to escalate to the fund's complaints process and the Private Health Insurance Ombudsman.
Worked estimates and checklists
How limit reset dates, waiting periods and staged treatment affect your extras dental benefit, with illustrative calculations and the questions to ask your fund.
