Variation of Dental Fees Within Geographic Areas: Economic Implications for Program Planners and Managers

Health administrators, benefits managers, and others who are responsible for procuring or arranging for dental services should be aware that dental fees charged vary considerably within geographic areas. This study examined dental fee information contained in a database commonly used by dental plan administrators for the period June – November 2009, as well as data from claims processed by a third party administrator. Ten common dental procedures were examined in each of twenty geographic areas of the US. For each geographic area, fees varied for each procedure. The “upper range” of fees between median and 90th percentile was greatest in Los Angeles (average 1.46x) and least in Charlotte (average 1.18x). Also examined was the “middle range” of fees, from the 25th to the 75th percentiles. The greatest fee variations were in Manhattan, White Plains, Dallas, and Los Angeles. In these areas the 25th percentile of fees was approximately thirty three percent lower than the 75th percentile fee amounts. Of the areas analyzed, the smallest variations were in Charlotte, Rochester, NY, and Portland, OR where the variation was approximately seventeen percent. In all geographic areas studied, dental fees are both “marked up” and “discounted” from the median, often by large percentages and dollar amounts. A problem for health administrators is that information about fees charged by particular dentists is not generally available. Useful data often may be obtained from fee schedules shown in insurance company publications and in information available from various dental networks or “Preferred Provider Organizations” (PPOs).