Chapter 1 Overview of Health Insurance

1.
Overview of the Health Insurance System
2.
Overview of the Medical Aid System
3.
Health insurance-related organizations and main tasks

Chapter 2: Basics of Dental Health Insurance Claims

1.
Composition of medical expenses
2.
Composition of patient out-of-pocket expenses
3.
Non-covered treatments at the dental clinic
4.
Medical examination fee calculation criteria

Chapter 3 Calculation Standards by Medical Item

1.
Treatment of basic dental diseases
2.
Prosthetic treatment
3.
root canal treatment
4.
Oral surgery treatment
5.
Periodontal treatment
6.
Dental implants

Chapter 4 Basic Billing-Related Affairs

1.
Nursing facility reporting work
2.
Dental treatment materials purchase report

Appendix (Reference Materials)

1.
Korean Standard Disease Classification Code (Dental) KCD-8 (Statistics Korea Notice No. 2020-175) Reference: Representative disease names
2.
Recent arbitration board announcements and review cases
3.
Level 3 Exam Scope and Past Questions

Beginning with the introduction of full resin dentures in 2012, scaling (full arch) in July 2013, partial dentures in July 2014, and dental implants in July 2014, these services have been contributing significantly to the increase in medical care costs.
In July 2015, metal-topped full dentures were covered, and in 2016, the age limit for covered implants and dentures was expanded to 65 years old. In 2017, the cost of fissure sealing and covered dentures was reduced, and in July 2018, the cost of covered implants was reduced, and so on. The coverage is continuously expanding.
After light-cured composite resin fillings for children under 12 years of age were covered by the National Health Insurance Service in 2019, the coverage became more specific in 2020, the criteria for root canal treatment were also expanded, and in 2021, due to the spread of the COVID-19 virus, the registration process, which had been conducted through in-person applications for those eligible for medical aid dentures, was simplified, and a new caries test item using quantitative photofluorescence, which was listed as a new medical technology, was established in June.
And in 2022, there were many changes in the reimbursement standards for procedures such as periodontal surgery and gingivectomy, and among them, the reimbursement standards for C-type root canals were newly established as the number of procedures improved.
Last year, the third-level relative value score system was revised, and the revised system reduced the bonus rate by 15% by organizing the bonus rate by type of nursing institution.
The 15% premium for each type of medical institution at the level of a member of the National Assembly has been reduced to '0%', and instead, the relative value score has been increased by 15%.


This year, the existing dental implant standards have finally been expanded to include zirconia-based prosthetic restorations, and there have also been changes to the target age and re-examination criteria for dental caries tests using quantitative photofluorescence.
Like this, every year, many things are changed, new things are established, and new things are added.
As a result, dental health insurance has become an essential element that all dentists must know, and its importance in dental management is expected to grow even further, so it is necessary to be aware of ongoing changes.

[2025 Dental Insurance Claimant Level 3 Practical Theory] The textbook is based on basic theory and focuses on essential and common treatments, and a medical record book has been inserted to allow for practice for each item.
We hope that this will be of practical help not only to students majoring in dental hygiene, but also to all those involved in dental health insurance, including dentists and dental hygienists, so that they can understand and apply it in their work.
The Korean Dental Health Insurance Association will continue to strive to establish a proper dental health insurance claim culture and contribute to the spread and expansion of health insurance.