TMJ Treatment Health Insurance Guide: Calculating Your Share and Checking Non-covered Splints

Temporomandibular (TMJ) disorder, disease code K07.6, is a condition for which health insurance costs are billed in Korea, and in the National Health Insurance Service (NHIS, 국민건강보험공단) analysis, the 2015 health insurance cost was KRW 30.3 billion. For examinations and insured tests and procedures you pay only a share according to the copayment rate, but the NHIS non-covered information portal lists making and adjusting occlusal splints such as the occlusal stabilization splint as non-covered items. So the starting point for TMJ treatment costs is to check the insured medical fee and the non-covered splint fee separately.

Published 2026-11-08 · Updated 2026-11-08 · DentalStatics editorial team

Key facts

Disease code	K07.6 temporomandibular joint disorders (source: Ministry of Health and Welfare (analysis by the National Health Insurance Service))
Health insurance cost	KRW 30.3 billion in 2015 (KRW 17.3 billion in 2010) (source: Ministry of Health and Welfare (analysis by the National Health Insurance Service))
Occlusal splints	Making and adjusting occlusal stabilization splints and others, relining and reconstruction are non-covered items (source: National Health Insurance Service non-covered information portal)
Clinic outpatient copayment	30% under age 65; for age 65 and over, KRW 1,500 if the total is KRW 15,000 or less (source: Health Insurance Review and Assessment Service (HIRA, 건강보험심사평가원))
Hospital-level outpatient copayment (dong area)	40% of the total insured medical cost (source: Health Insurance Review and Assessment Service (HIRA))
Jaw and face corrective surgery for appearance	Non-covered unless its purpose is to improve chewing or speech function (source: National Health Insurance Service (NHIS))

Does health insurance cover TMJ disorder care?

TMJ disorder is a condition eligible for health insurance benefits, and health insurance applies to the consultation fee and the tests and procedures designated as insured. In the NHIS analysis released by the Ministry of Health and Welfare, health insurance costs for TMJ disorder rose from KRW 17.3 billion in 2010 to KRW 30.3 billion in 2015, most of it outpatient costs.

However, even for care received on the same day, whether each item is covered differs. On a TMJ care receipt, the copayment and NHIS-paid amount of insured items and the non-covered items are shown in separate columns, so checking how the receipt is organized after the first visit makes later costs easier to predict.

Which items in TMJ treatment are paid as non-covered?

The NHIS non-covered information portal lists the occlusal stabilization splint, immediate anterior positioning splint, soft occlusal stabilization splint and anterior repositioning splint, plus adjustment, relining and reconstruction of splints, as items related to TMJ disorder. The cost of these splints is not covered by health insurance, so the amount differs by clinic.

For large treatments such as jaw and face corrective surgery, coverage depends on purpose. The medical care benefit standards designate jaw and face corrective surgery for appearance, not for improving chewing and speech function, as non-covered, so the cost structure varies greatly depending on whether it is for a functional problem or for appearance.

How is the copayment for TMJ care calculated?

The copayment for insured items in TMJ care is calculated at set rates by type of medical institution and age. Based on HIRA standards, it is as below, and non-covered items are paid in full by the patient regardless of these rates.

Dental clinic outpatient, under age 65: 30% of the total insured medical cost
Dental clinic outpatient, age 65 and over: KRW 1,500 if the total is KRW 15,000 or less, otherwise 10-30% by bracket
Hospital-level outpatient such as a dental hospital (dong area): 40% of the total insured medical cost
Ages 1 to under 6: 70% of the standard patient copayment rate

How do you compare non-covered TMJ costs?

For non-covered splint fees, even under the same name the actual burden differs depending on whether impressions, the first adjustment and later regular adjustments are included. When you get a splint estimate, asking for the splint fee and adjustment fee to be written separately makes it easy to compare clinics.

The NHIS non-covered information portal has item price information and a non-covered statistics menu, so you can search for occlusal splint items and consult the published price data. Before starting TMJ treatment, it is good to go through the process of having non-covered items such as splints and their amounts explained and agreeing to them.

What should you prepare when filing a private medical insurance claim?

Whether private indemnity medical insurance covers TMJ treatment costs, especially non-covered splints, depends on when you enrolled and on the policy terms. Telling the insurer the disease code K07.6 and the treatment items before TMJ treatment and confirming coverage first can reduce later disputes.

When claiming TMJ treatment costs, keep the medical fee receipt and the detailed itemized statement, and submit documents showing the diagnosis name and disease code together if the insurer asks. For treatment that takes several visits, collect the receipt every time you visit. For large non-covered items such as splints, also check that the item name is written accurately on the receipt.

Common myths and facts

Myth: TMJ treatment is entirely non-covered.

TMJ disorder is a condition for which health insurance costs are billed, and health insurance applies to examinations and insured items. Only some items, such as occlusal splints, are non-covered.

Myth: Splint costs are the same at every dental clinic.

A splint is a non-covered item, so each clinic sets its own amount. You need to compare whether fabrication and adjustment costs are included.

Frequently asked questions

Is a TMJ MRI covered by health insurance?

Whether TMJ imaging is covered depends on the purpose of the test and the recognition criteria, so it is hard to give one answer. If a test is recommended, ask in advance whether coverage applies and what the expected copayment is.

Is TMJ care cheaper for people aged 65 and over?

For dental clinic outpatient care at age 65 and over, there is a fixed-amount bracket in which you pay only KRW 1,500 if the total insured cost is KRW 15,000 or less. If the total exceeds this, bracket rates apply, and this reduction does not apply to non-covered items.

Is botulinum toxin injection for the jaw joint covered by insurance?

Botulinum toxin injection is introduced as one of the non-surgical treatments for TMJ disorders, but whether it is covered depends on the purpose and criteria. Check before the procedure whether it is covered or non-covered.

What should I look at on a TMJ care receipt?

Look separately at the columns for the copayment of insured items, the NHIS-paid amount and non-covered amounts. Checking how much items like splints are charged in the non-covered column also lets you estimate the cost of the next visit.

Can Medical Aid recipients also receive TMJ treatment?

Medical Aid recipients can also receive TMJ disorder care, and the copayment for insured items follows Medical Aid standards. Non-covered costs such as splints can arise separately even for Medical Aid recipients, so check before treatment.

References

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