What Is My Dental Treatment Going To Cost? Understanding Customary Dental Fees.


What Are Customary Dental Fees?

What a dentist charges for services can be difficult to determine. A dentistry fee for a particular treatment like a crown or root canal starts with understanding the specific treatment. For instance, a common filling for a cavity can have many different aspects. Depending upon the numbef of sides that have decay, whether the roots are affected, the extent of damage and so forth. The concept of customary dental fees helps us understand what the final bill will be. Here's how it works: (Continued After Table...)


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CATEGORY DESCRIPTIONS FEES METRO AREA STATE
DIAGNOSTIC D0120 Periodic oral evaluation $33 National Sample NA
DIAGNOSTIC D0150 Comprehensive oral evaluation $53 National Sample NA
DIAGNOSTIC D0274 X-Ray: Bitewings-4 films $49 National Sample NA
PREVENTIVE D1110 Prophylaxis-adult $58 National Sample NA
RESTORATIVE D2140 Amalgam filling-1 surface, primary or permanent $88 National Sample NA
RESTORATIVE D2330 Resin-based filling composite 1 surface, anterior $108 National Sample NA
RESTORATIVE D2750 Crown-porcelain fused to high noble metal $760 National Sample NA
ENDODONTICS D3330 Molar (excluding final restoration) $780 National Sample NA
PERIODONTICS D4341 Periodontal scaling and root planing, 4 or more teeth, per quad. $181 National Sample NA
PROSTHODONTICS D5110 Complete denture-maxillary $850 National Sample NA


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Although the designation of fee classes (which includes "Customary Dental Fees") can apply to both those without dental insurance and those with, these designations are really saying how much the insurer is willing to pay the dentist for your care. This is important because whatever portion the insurer doesn't pay, you'll have to make up. The basis for this payment scheme is what your employer (or in rare cases an individual dental plan) is contracted to pay. Beyond this is the normal "deductible" and "co-pay" which are also your (as the patient) responsibility to pay in addition to any "shortage" not made up by the insurer. So when determining "customary dental fees," the insurers use something called UCR which is really an abbreviation for "usual, customary and reasonable." Although defintiions vary, these are typically what insurers refer to when deciding their portion of the payment:

- Usual fee, as it sounds, is what the dentist will typically charge for a treatment if left to their own devices, usually in the form of a fee table that is created by them
"- Customary " fee basically is the top fee designated by your insurance carrier's policy or contract, in effect what it typically will pay based on the area where the dentist is
"- Reasonable " fee is what could be charged for non-standard or extenuating circumstances, in effect if the dentist can justify more expenses based on the required treatment approach

These "UCR" based payment approaches end up paying some portion of the fee based on one of the above approaches, typically whatever is the least expensive for them. And as we discussed, plans vary as to the percentage of what they will pay. How each plan determines what they will pay is really up to that plan administrator and what they feel they can operate under and still acheive their profit goals. While there are certainly typical fees for a given area (as noted in the database table above which you can determine by noting your area and the procedure you are interested in), the plans are totally empowered to in effect decide what they will pay. The same treatment for patients under the same plan can be reimbursed differently as well, so this method makes for some pretty uneven (or unfair) results. You (or your dentist, although you may have more power in this situation than they do) can protest the fees and give reasons for why the reimbursement should be higher. There are other techniques such as trying to get the medical insurance to pay for certain procedures that apply. Often your company's benefits administrator is your best ally because they have control over whether the carrier's policy will be continued the following year.

In determining what the fees will be, all dentists should provide a treatment plan, preferably in writing. This is the estimate of what the dentist fee will be upon completion of the treatment. The discussion of what discounts and dental rates being charged should occur at the time the plan is presented. Using the treatment plan to compare or get a second opinion insurance a more accurate comparison than just using verbal descriptions. The codes or customary dental fees that are on this treatment plan and can be interpreted by other practices as well in case you wish to get a second opinion.