Solving the Mystery of Dental Fees and Insurance

By Elaina O’Toole

It’s no secret that dental care costs are always on the rise. Dental care is not a commodity. It’s not coffee or milk or wireless minutes. It’s a professional service that’s both art and a science. The skill and experience of dentists varies widely as do their fees.

One major factor in the cost charged for a restorative dental procedure, such as a crown, is the cost charged by the dental lab to fabricate the crown. Dental labs differ in the quality of the products they produce. In addition to proper planning by the dentist, the fit and longevity of the crown is dependent on the skill of the lab technician and quality of the materials used.

Lab fees along with overhead costs such as payroll, business insurance, taxes, dental supplies and technology are just some of the expenses a dentist must pay as a business owner. Because these costs are continually rising, dentists must raise their fees to stay profitable. Anywhere from 60 to 80 percent of what a patient pays goes toward the expense of running a modern dental practice.

Many patients expect their dental insurance to pay for their dental care. However, the divide between patients’ expectations of their dental insurance coverage and the actual coverage that’s provided continues to widen. Dental insurance is nothing like health insurance or auto insurance. It’s really a maintenance plan that usually pays toward preventive care such as cleanings and X-rays but typically covers very little in the way of restorative procedures like root canals, crowns, bridges, etc.

Insurance plans are contracts between a patient’s employer and the dental insurance company, so coverage varies greatly. However, the vast majority of plans only offer a $1,000 to $1,500 maximum annual benefit. In other words, once a patient receives $1,000 to $1,500 in benefits for a given year, any additional dental care costs will have to be paid out-of-pocket. Dental insurance was first introduced to the market in the mid-1960s and early 1970s. Delta Dental offered insurance with a yearly maximum of $1,000 in 1972. And $1,000 bought a lot of dental care in 1972. Today, the average maximum annual benefit on dental plans is still $1,000! So in over 40 years, the benefit has not gone up.

If a dentist doesn’t “take” insurance, i.e., participate with any insurance companies, that’s usually an indication that he or she will be a pretty good dentist. Dentists who don’t participate with insurance companies can take more time with their patients and don’t have to work under the constraints insurance companies apply. Even if a dentist does not participate with insurance companies that dentists can file claims on the patient’s behalf to maximize the patient’s benefits. As long as the patient does not have HMO insurance, the patient can receive out-of-network benefits at a non-participating practice.

So, it’s important to keep in mind that dental insurance is meant to help consumers maintain their general dental health with coverage for regular cleanings and X-rays.  Restorative procedures are typically covered at a lower percentage and the fees for these more costly procedures can cause a patient to quickly exceed their maximum annual benefit.

As mentioned earlier, the cost of restorative procedures can vary significantly by practitioner. The quality of the lab work and materials used as well as the dentist’s skill level are typically reflected in a practice’s fees. The old adage is as true in dentistry as it is in buying a car: You get what you pay for.


Elaina has worked with Drs. Woody Wooddell and Joe Passaro to manage their dental practice in Davidsonville for more than 15 years. Visit their website at or call 410.956.5555 for more information.


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