Major dental cover is the part of extras that pays towards bigger dental work like crowns, bridges, complex fillings and extractions. It usually has a 12-month waiting period and an annual limit, so it pays to have it in place before you need it.
Key points
- Major dental covers significant work such as complex fillings, extractions, crowns and bridges. Each fund decides exactly what counts as major.
- It's part of extras cover, not hospital cover, and usually has a 12-month waiting period.
- Dental is the most claimed extras service: 14.7 million services in the June 2026 quarter, with an average benefit of $68 per service across all dental.
- Wisdom teeth removed in hospital fall under the dental surgery category of hospital cover, which Silver and Gold must include.
- Medicare doesn't cover most dental for adults.
What counts as major dental?
privatehealth.gov.au defines major dental as significant dental services, such as complex fillings, tooth extractions, crowns and bridges. Whether a specific item is general or major depends on each fund's rules, so check your policy. Orthodontics (braces) and endodontics (root canals) are often listed separately with their own limits.
| Usually general dental | Usually major dental | Often listed separately |
|---|---|---|
| Check-ups, cleans, x-rays, simple fillings | Complex fillings, extractions, crowns, bridges, dentures | Root canals (endodontics), braces (orthodontics) |
Source: privatehealth.gov.au, general treatments definitions.
How major dental cover pays
Funds pay either a set dollar amount or a percentage of the fee for each item, up to an annual limit for major dental. Limits often grow the longer you stay with the fund. Some funds pay more at their own or partner dentists.
| Extras service, June 2026 quarter | Services claimed | Average benefit per service |
|---|---|---|
| Dental | 14.7 million | $68 |
| Physiotherapy | 3.3 million | $43 |
| Optical | 2.7 million | $84 |
| Chiropractic | 2.3 million | $36 |
Source: APRA, Quarterly private health insurance membership and benefits summary, June 2026. Members paid an average of $64.05 out of pocket per extras service.
Waiting periods: extras waits are set by each fund. privatehealth.gov.au says they're generally 2 to 6 months for things like general dental, optical and physio, and 12 months or more for major items such as orthodontics or hearing aids.
When dental work is covered by hospital cover
If you're admitted to hospital for dental surgery, such as removing impacted wisdom teeth under general anaesthetic, the hospital costs fall under the dental surgery category. That's a Silver category, so Silver and Gold policies must cover it. The dentist's or oral surgeon's fees aren't covered by Medicare in most cases, so check what your extras pay.
Source: privatehealth.gov.au, clinical categories.
Does Medicare cover dental?
Mostly not, for adults. Eligible children aged 0 to 17 can use the Child Dental Benefits Schedule for basic services, and public dental services are available for some concession card holders through state programs, often with waiting lists.
Four situations
These use illustrative fees and benefits, not real quotes or policy terms.
Single, 34, needs a crown
On an illustrative $1,800 crown with a 60% benefit, the fund pays about $1,080 if within the annual limit.
Couple, 41 and 43, just joined
Major dental waits are usually 12 months, so no benefit yet. Planning ahead matters.
Family, teen with impacted wisdom teeth
Hospital cover pays the hospital for dental surgery; extras may help with the surgeon's fees.
Single, 70, needs dentures
Dentures are commonly major dental. Check the limit and whether it's per year or longer.
Illustrative only. Fees, benefit percentages and limits are made up for the examples.
Compare extras policies with major dental benefits.
Compare health insuranceMajor dental cover: your questions answered
Is there a waiting period for major dental?
Usually 12 months. Some funds run offers that shorten waits, so check the conditions.
Is a root canal major dental?
It's often listed separately as endodontics, with its own limit. Check your policy.
Does hospital cover pay for wisdom teeth removal?
If you're admitted, hospital costs fall under dental surgery, a Silver category. Extras may help with the surgeon's fees.
Do major dental limits reset each year?
Most do, on 1 January or your policy anniversary. Some limits increase with membership length.
Can I claim crowns on general dental?
Usually not. Crowns are typically major dental, with a separate limit and longer wait.
Does Medicare cover dental for adults?
Generally no, apart from limited public dental programs for eligible concession card holders.
Sources
- Australian Government, privatehealth.gov.au, General treatments (extras) definitions
- APRA, Quarterly private health insurance membership and benefits summary, June 2026
- Australian Government, privatehealth.gov.au, Waiting periods
- Australian Government, privatehealth.gov.au, Clinical categories
Things you should know
This article is general information only and doesn't take your personal circumstances into account. Konkrd compares policies from a range of funds. Prices, products and offers change often and vary by state, excess and rebate tier. Read a policy's Private Health Information Statement before buying.
