The short answer
German statutory health insurance (gesetzliche Krankenversicherung, GKV) covers the treatment of dental disease — examinations, fillings, root canal treatment (Wurzelbehandlung) where the tooth can sensibly be kept, extractions, the treatment of gum disease after a documented assessment, and acute pain. It does not cover comfort, appearance or the most durable version of everything: professional cleaning for adults, whitening, veneers, clear aligners (Aligner) for adults and the implant itself (Implantat) are private services. In between sits a third category that surprises people most — treatments the fund pays for up to a standard level, where you may choose something more elaborate and pay the difference. The legal yardstick behind all of this is written into the social code: statutory care must be adequate, appropriate and economical. “Economical” is the word doing the work.
Three buckets, not two
Newcomers arrive expecting a yes-or-no list. The German system has three answers, and knowing which one applies to a given tooth explains almost every bill you will ever receive.
Bucket one — covered. You present your card, the practice bills your fund, and you pay nothing. This is where the great majority of everyday dentistry lives.
Bucket two — covered to a standard. The fund pays for a solution that does the job properly. If you want a different material or technique, the fund’s share stays the same and you pay the difference, under a written agreement signed before treatment.
Bucket three — private from the first euro. The fund contributes nothing, because the treatment is not classed as medically necessary care. You are told the price in advance and you decide.
Bucket one: what the card simply covers
The check-up
The routine examination (Kontrolluntersuchung) is covered, and it is also the appointment that earns your stamp in the Bonusheft — the booklet that later raises the subsidy towards crowns and dentures. Missing a year costs you nothing today and something quite specific in ten years’ time, which is exactly why Bonusheft: why you should start it today exists.
Diagnosis and ordinary X-rays
Conventional X-rays are covered where there is a clinical reason for them. A 3D X-ray (DVT) is a different matter: it is a private service in most situations, and in our practice it costs 178 €. It is worth knowing that figure in advance, because the DVT is where a routine appointment most often crosses into private territory.
Fillings and tooth preservation
A filling (Füllung) that properly restores a decayed tooth is covered, including the local anaesthetic (Betäubung). What is not covered is the upgrade — see bucket two.
Root canal treatment
Covered, when the tooth meets the criteria for being worth preserving under the statutory rules. Those criteria look at whether keeping the tooth maintains a usable row of teeth, not at how attached you are to it. Where a tooth falls outside them, root canal treatment is still possible as a private service, and the alternative — extraction — is covered. Ask which situation you are in; it is a fair question and the answer is not always obvious from the chair.
Extractions and oral surgery
Removing a tooth is covered, including the surgical removal of a wisdom tooth (Weisheitszahn) where there is a medical indication. Sedation and laughing gas (Lachgas) for anxious patients are separate: they are comfort services, and they are private in the statutory system.
Gum disease
Treatment for periodontitis (Parodontitis) is covered, but not on demand. The fund requires a documented assessment first, then approves a defined course of treatment including a structured follow-up phase. It is one of the few areas where the paperwork genuinely serves the patient, because the follow-up is where the result is kept.
Acute pain and infection
Always covered, including out of hours. Nobody in Germany is left with an abscess because it is a Sunday — the mechanics are in Emergency dentist: what to do out of hours.
Children and adolescents
Considerably more generous than for adults: regular preventive appointments, instruction in cleaning, fluoride application and the sealing of the grooves in permanent back teeth are all part of the statutory programme for children and young people. If you have brought a family to Germany, this is the part of the system that will pleasantly surprise you.
Bucket two: covered to a standard, you top up
This is where most misunderstandings begin, and it is a genuinely fair mechanism once you see it.
Fillings. The fund covers a filling in the standard technique. Want a laboratory-made inlay (Inlay), or a more elaborate layering technique on a large cavity? You sign an additional-cost agreement (Mehrkostenvereinbarung) and pay the difference, while the fund’s share for the standard filling still counts towards it.
Crowns and dentures. The fund pays a fixed subsidy (Festzuschuss) based on the finding in your mouth, not on the treatment you choose. Bridge, crown, denture, implant-supported work — the subsidy is the same for a given finding, and everything above it is your share (Eigenanteil). The exact 2026 amounts, and why the subsidy rises with an unbroken Bonusheft, are set out in Festzuschuss explained: the fixed subsidy.
Orthodontics for children. Covered when the misalignment reaches a defined severity grade (KIG, Kieferorthopädische Indikationsgruppen). Milder cases are graded as not requiring treatment at the fund’s expense, and parents who want them treated pay privately. Clear aligners for adults are outside the catalogue entirely.
Bucket three: private from the first euro
| Treatment | Statutory position |
|---|---|
| Professional cleaning (PZR) for adults | Generally not a standard benefit; many funds pay a voluntary subsidy — ask yours |
| Whitening and cosmetic work | Not covered |
| Veneers | Not covered |
| Clear aligners for adults | Not covered |
| The implant itself (screw and surgery) | Private; the fund pays only the fixed subsidy for the crown on top |
| 3D X-ray (DVT) | Private in most situations |
| Sedation and laughing gas | Private |
| Night guard for teeth grinding | Covered where there is a medical indication, otherwise private |
Two entries deserve a sentence more. Professional cleaning is the treatment expats ask about most, because in the UK, the US and much of Asia it is a routine covered appointment. In Germany it usually is not — although funds increasingly reimburse part of it as a voluntary extra, and it is worth one email to yours before you book. What it involves, and why it is booked separately from a check-up, is described on Prevention and professional cleaning (PZR) – service page (EN).
Implants are the other one. The rule is not that the fund refuses everything: it does not pay for the implant, but it pays the same subsidy for the crown or denture on top as it would for a conventional solution. In a small number of tightly defined exceptional situations the fund’s contribution goes further; those cases are decided individually and your dentist will tell you if you are in one.
"Das ist eine Privatleistung" — the sentence that changes your bill
Sooner or later a German dental practice will say this to you: that is a private service. It is not a sales tactic, it is a legal category, and it triggers rights.
You must be told in advance and in writing. A private service in a statutory patient’s mouth requires a written agreement, signed before treatment, stating what will be done and what it costs. If nobody has shown you a document, nothing should be starting.
You may say no. Declining a private service does not affect your entitlement to covered treatment. The covered alternative — if there is one — must still be offered to you.
Ask the two questions. What does statutory insurance cover in my case? and what exactly do I gain by paying more? A good answer is concrete: longer likely lifespan, better fit, less tooth substance removed, a better result at the front of the mouth. A vague answer is a reason to think about it overnight.
Ask in a language you actually think in. Financial consent given in a language you half-understand is the weakest kind of consent there is. In our practice this conversation happens in English as a matter of routine, and if you are still choosing a practice, English-Speaking Dentist in NRW sets out what to ask before you book.
If money is tight
The statutory system has a hardship provision (Härtefallregelung) for people below defined income limits, which raises the subsidy for dentures up to the full cost of the standard option — the details are in Low income and dental care: the hardship provision. Beyond that, two practical routes exist: treatment can often be staged, so that the urgent work happens now and the rest follows, and instalment payment (Ratenzahlung) is available in many practices, ours included, subject to a credit decision. Neither route requires you to explain yourself.
What to expect without asking — and when to ask before you agree
For the treatment of disease, effectively yes: examinations, fillings, root canals, extractions and gum treatment are billed to your fund and cost you nothing at the desk. “Free” stops at anything prosthetic, cosmetic or comfort-related, where you either top up to a fixed subsidy or pay in full.
Almost always because part of what was done sits in bucket two or three — a private service, or an upgrade beyond the standard solution. Look for the agreement you signed before treatment; it should list exactly those items. If you cannot find one, ask the practice to show you which document authorised the charge.
Not as a standard benefit for adults. Many funds now reimburse a share of it as a voluntary extra, and the amount and conditions differ from fund to fund, so the answer genuinely depends on the letters on your card. One email to your fund settles it.
It depends on the severity grade (KIG) assigned after an orthodontic assessment. Cases from a defined level of severity upwards are covered; milder ones are treated privately if the family chooses. Get the assessment first — the grade, not the appearance, decides.
Conventional X-rays are, where there is a clinical reason. A 3D X-ray (DVT) is a private service in most situations; in our practice it costs 178 €. It is used where two-dimensional images cannot answer the question — before implant surgery, for instance, or for a complicated root.
Nobody can tell you from a distance, because your share is the total cost minus a fixed subsidy that depends on the finding and on your Bonusheft. That is precisely what the treatment and cost plan (Heil- und Kostenplan, HKP) is for: it shows both numbers before you commit — see Heil- und Kostenplan: the document you should never sign unread.
Statutory insurance in Germany is generous about disease and strict about everything else. If a tooth hurts, is decayed, is infected or has to come out, your card covers it. If you want the more durable, more discreet or more comfortable version, you will be asked to sign for the difference — in advance, in writing, with the covered alternative still on the table. Learn the three buckets and no German dental bill will ever surprise you again.
Zahnarztpraxis Tsypin · Wuppertal. This article was medically reviewed and is provided for information; it does not replace an examination. Updated August 2026.
