DENTAL SERVICES

Information on 

Coverage, Payments, 

and Fee Variation

Report to the Chairman, Subcommittee 

on Primary Health and Aging, 

Committee on Health, Education, 

Labor, and Pensions, U.S. Senate

September 2013

GAO-13-754

United States Government Accountability Office
United States Government Accountability Office

Highlights of GAO-13-754, a report to the 

Chairman, Subcommittee on Primary Health 

and Aging, Committee on Health, Education, 

Labor, and Pensions, U.S. Senate

September 2013

DENTAL SERVICES

Information on Coverage, Payments, and Fee 

Variation 

Why GAO Did This Study

High rates of dental disease remain 

prevalent across the nation, especially 

in vulnerable and underserved 

populations. According to national 

surveys, 42 percent of adults with tooth 

or mouth problems did not see a 

dentist in 2008 because they did not 

have dental insurance or could not 

afford the out-of-pocket payments, and 

in 2011, 4 million children did not 

obtain needed dental care because 

their families could not afford it.

In 2011, the Institute of Medicine 

reported that there is strong evidence 

that dental coverage is positively tied 

to access to and use of oral health 

care. For families without dental 

coverage, federally funded health 

centers may offer an affordable dental 

care option. Health centers are 

required to offer sliding fee schedules 

with discounts of up to 100 percent for 

many low-income patients.

GAO was asked to examine dental 

services in the United States. This 

report describes (1) trends in coverage 

for, and use of, dental services;

(2) trends in payments by individuals 

and other payers for dental services; 

and (3) the extent to which dental fees 

vary between and within selected 

communities across the nation. To do 

this work, GAO examined HHS 

national health survey data and 

national dental expenditure estimates, 

dental insurance claims data, and 

health center dental fees in 18 selected 

communities (based on census region, 

population, and dental claims volume). 

GAO also interviewed HHS officials 

and academic experts.

HHS provided technical comments on 

a draft of this report, which were 

incorporated as appropriate.

What GAO Found

Overall, trends in dental coverage show little change from 1996 to 2010—around 

62 percent of individuals had coverage. The percentage of the population with 

private dental coverage decreased from 53 to 50 percent (see fig.). Dental 

coverage through Medicaid or the State Children’s Health Insurance Program 

(CHIP), which was established in 1997, rose from 9 to 13 percent. The increase 

was due primarily to an increase in the number of children covered by these 

federal-state health programs with mandated pediatric dental coverage. 

Individuals with no dental coverage decreased from 28 to 25 percent, and 

coverage for 10 to 12 percent of the population was unknown. Use of dental 

services—the percentage of individuals who had at least one dental visit—also 

remained relatively unchanged at around 40 percent from 1996 to 2010. 

Medicaid and CHIP beneficiaries, children in particular, showed increases in the 

use of dental services (from 28 to 37 percent), but still visited the dentist less 

often than privately insured children (58 percent in 2010).

Dental Coverage Status, 1996 and 2010

Note: For 2010, Medicaid included children in the State Children’s Health Insurance Program.

GAO’s analysis showed that average annual dental payments—the total amount 

paid out of pocket by individuals and by other payers—increased 26 percent, 

inflation-adjusted, from $520 in 1996 to $653 in 2010. Average annual out-ofpocket payments increased 21 percent, from $242 to $294, for individuals with 

private insurance and 32 percent, from $392 to $518, for individuals with no 

dental coverage.

Dental fees charged by local dentists and health centers varied widely. For 8 

of 24 common procedures GAO examined, reported upper-end fees (the 

95th percentile of the range in local dentist fees) were at least double the 

midpoint fees (the 50th percentile of the range in local dentist fees) in several 

communities. For example, in Miami, Florida, the upper-end fee of $150 for a 

periodic oral examination was more than twice the midpoint dental fee of $62. 

Dental fees also varied between local dentists billing private insurers and health 

centers serving residents of the same community. In general, most health 

centers in GAO’s review offered a 100 percent discount—resulting in no fee—to 

the lowest-income patients for many, but not all, dental services.

View GAO-13-754. For more information, 

contact Katherine Iritani at (202) 512-7114 or 

iritanik@gao.gov.
Page i GAO-13-754 Dental Services Coverage and Payments

Letter 1 

Background 6

National Survey Data Show That Rates of Dental Coverage and Use 

of Dental Services Remained Generally Unchanged from 1996 to 

2010 10

Average Payments for Dental Services Increased from 1996 to 2010 18

Fees Charged for Dental Services Varied between and within 

Communities 22

Agency Comments 30

Appendix I National Dental Expenditures 32

Appendix II Urban and Rural Dental Visit Rates 33

Appendix III Scope and Methodology 34

Appendix IV Dental Fees Charged for Common Dental Procedures in 

18 Communities 38

Appendix V GAO Contact and Staff Acknowledgments 74

Related GAO Products 75

Tables

Table 1: Categories and Examples of Dental Services 6

Table 2: Descriptions of Dental Coverage within Certain Federal 

Health Programs 8

Table 3: Percentage of Individuals with a Dental Visit, 1996, 2004, 

and 2010 15

Table 4: Percentage of Individuals with a Dental Visit, by Coverage 

Status, 1996, 2004, and 2010 15

Contents 
Page ii GAO-13-754 Dental Services Coverage and Payments

Table 5: Average Annual Dental Payments for Individuals with a 

Dental Visit, Adjusted for Inflation, by Coverage Status, 

1996, 2004, and 2010 18

Table 6: Procedures with the Largest Percentage Difference 

between Midpoint and Upper-End Fees, 2012 25

Table 7: Differences between Midpoint and Upper-End Dental Fees 

Charged for a Periodic Oral Evaluation of an Established 

Patient, by Local Dentists in 18 Communities in Nine 

States, 2012 26

Table 8: Differences between Midpoint and Upper-End Dental Fees 

Charged for a Filling by Local Dentists in 18 Communities 

in Nine States, 2012 27

Table 9: Dental Fees Charged for a Tooth Extraction by Local 

Dentists and Health Centers in 18 Communities in Nine 

States, 2012 29

Table 10: Dental Fees Charged for Common Procedures in 

Phoenix, Arizona (850), 2012 38

Table 11: Dental Fees Charged for Common Procedures in 

Flagstaff, Arizona (860), 2012 40

Table 12: Dental Fees Charged for Common Procedures in Los 

Angeles, California (900), 2012 42

Table 13: Dental Fees Charged for Common Procedures in Fresno, 

California (936), 2012 44

Table 14: Dental Fees Charged for Common Procedures in Miami, 

Florida (331), 2012 46

Table 15: Dental Fees Charged for Common Procedures in Palm 

Coast, Florida (321), 2012 48

Table 16: Dental Fees Charged for Common Procedures in 

Chicago, Illinois (606), 2012 50

Table 17: Dental Fees Charged for Common Procedures in 

Champaign, Illinois (618), 2012 52

Table 18: Dental Fees Charged for Common Procedures in Boston, 

Massachusetts (021), 2012 54

Table 19: Dental Fees Charged for Common Procedures in 

Pittsfield, Massachusetts (012), 2012 56

Table 20: Dental Fees Charged for Common Procedures in 

Minneapolis, Minnesota (554), 2012 58

Table 21: Dental Fees Charged for Common Procedures in 

Mankato, Minnesota (560), 2012 60

Table 22: Dental Fees Charged for Common Procedures in New 

York, New York (100), 2012 62
Page iii GAO-13-754 Dental Services Coverage and Payments

Table 23: Dental Fees Charged for Common Procedures in Elmira, 

New York (148), 2012 64

Table 24: Dental Fees Charged for Common Procedures in 

Nashville, Tennessee (372), 2012 66

Table 25: Dental Fees Charged for Common Procedures in 

Jackson, Tennessee (382), 2012 68

Table 26: Dental Fees Charged for Common Procedures in Dallas, 

Texas (752), 2012 70

Table 27: Dental Fees Charged for Common Procedures in San 

Angelo, Texas (768), 2012 72

Figures

Figure 1: Dental Coverage Status, 1996, 2004, and 2010 12

Figure 2: Rates of Private Dental Coverage, by Income Level, 1996, 

2004, and 2010 13

Figure 3: Dental Coverage Rates for Children, Ages 0-20 Years, 

1996, 2004, and 2010 14

Figure 4: Percentage of Children, Ages 0-20 Years, with Private and 

Medicaid Dental Coverage with a Dental Visit, 1996, 2004, 

and 2010 16

Figure 5: Types of Dental Services as a Proportion of Total 

Services, 1996, 2004, and 2010 17

Figure 6: Average Annual Payments for Dental Services for 

Individuals with a Dental Visit, Adjusted for Inflation, by 

Income Level, 1996, 2004, and 2010 20

Figure 7: Average Annual Out-of-Pocket Payments for Individuals 

with a Dental Visit, 1996, 2004, and 2010 21

Figure 8: Midpoint Dental Fees in 18 Communities for Teeth 

Cleaning (Adult and Child), 2012 23

Figure 9: National Expenditures for Dental Services, Adjusted for 

Inflation, 1996-2011 32

Figure 10: Percentage of Individuals with a Dental Visit, by Age and 

Location, 2008-2010 33
Page iv GAO-13-754 Dental Services Coverage and Payments

Abbreviations

ADA American Dental Association

AHRQ Agency for Healthcare Research and Quality

CDT Current Dental Terminology

CHIP State Children’s Health Insurance Program

CMS Centers for Medicare & Medicaid Services

CPI-U Consumer Price Index for All Urban Consumers

FPL federal poverty level

HHS Department of Health and Human Services

HRSA Health Resources and Services Administration

MEPS Medical Expenditure Panel Survey

PPACA Patient Protection and Affordable Care Act

VA Department of Veterans Affairs

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Page 1 GAO-13-754 Dental Services Coverage and Payments

441 G St. N.W.

Washington, DC 20548

September 6, 2013

The Honorable Bernard Sanders

Chairman

Subcommittee on Primary Health and Aging

Committee on Health, Education, Labor, and Pensions

United States Senate

Dear Mr. Chairman:

More than a decade ago, the Surgeon General’s report on oral health 

described the poor oral health of our nation as a “silent epidemic.”1

Today, high rates of dental diseases remain prevalent across the nation, 

especially in vulnerable and underserved populations. The cost of dental 

care and lack of dental coverage are often cited as reasons individuals 

may not seek needed dental care.2 In 2008, 42 percent of adults with 

tooth or mouth problems reported they did not see a dentist because they 

did not have dental coverage or could not afford the out-of-pocket 

payments.3 Similarly, in 2011, 4 million children did not obtain needed 

dental care because their families could not afford it.4 The Institute of 

Medicine has reported that there is strong evidence that dental coverage 

is positively associated with access to and use of oral health care.5

 

1

U.S. Department of Health and Human Services, National Institute of Dental and 

Craniofacial Research, National Institutes of Health, Oral Health in America: A Report of 

the Surgeon General (Rockville, Md.: 2000). 

2

Individuals can obtain dental coverage from private insurance or public programs 

including Medicaid, Medicare, Veterans Affairs, or state sponsored programs.

3

B. Bloom, C.M. Simile, P.F. Adams, and R.A. Cohen, Oral Health Status and Access to 

Oral Health Care for U.S. Adults Aged 18–64: National Health Interview Survey 2008, Vital 

and Health Statistics 10(253) (Hyattsville, Md.: National Center for Health Statistics, 

2012). For our report, insurance premiums were not included in out-of-pocket payments.

4

B. Bloom, R.A. Cohen, and G. Freeman, Summary Health Statistics for U.S. Children: 

National Health Interview Survey, 2011, Vital and Health Statistics 10(254) (Hyattsville, 

Md.: National Center for Health Statistics, 2012).

5

Institute of Medicine and National Research Council, Improving Access to Oral Health 

Care for Vulnerable and Underserved Populations. The National Academies Press 

(Washington, D.C.: 2011). For example, one study found that individuals who did not have 

dental insurance were about two-thirds less likely to have a dental visit than individuals 

with private insurance. 

 
 

Page 2 GAO-13-754 Dental Services Coverage and Payments

Recognizing that oral health is central to a person’s overall health and 

well-being, the Department of Health and Human Services (HHS) has 

adopted an oral health objective as a leading health indicator in its 

Healthy People 2020 initiative, which consists of 10-year national 

objectives for improving the health of all Americans.6

Many families that cannot afford dental care obtain it from health centers, 

for which federal funds provide a substantial part of revenue. Dental 

services that are provided by health centers must be available to all 

patients, regardless of their ability to pay. All health centers must have fee 

schedules for all services, including any dental services provided, that 

reflect prevailing fees in the area and a schedule of discounts (or sliding 

fee schedule) for individuals who earn annual incomes equal to or less 

than 200 percent of the federal poverty level (FPL). 

Specifically, HHS’s 

leading indicator for oral health is to increase the proportion of children, 

adolescents, and adults who used the oral health care system in the past 

12 months. The 2020 target for this leading health indicator is to increase 

access to dental services—increasing the proportion of individuals aged 

2 years and older who have had a dental visit in a year to 49.0 percent 

from 44.5 percent in 2007.

You asked us to examine dental coverage, and use of and payments for 

dental services in the United States. This report describes (1) trends in 

coverage for and use of dental services, (2) trends in payments for dental 

services made by individuals and other payers, and (3) the extent to 

which dental fees vary between and within selected communities across 

the nation. You also asked us to examine national expenditures for dental 

services. We report national dental expenditures from 1996 through 2011 

in appendix I.

To provide information on trends in dental coverage and the use of dental 

services by type of coverage, we obtained and analyzed data files from 

the Medical Expenditure Panel Survey (MEPS) for 1996, 2004, and 2010 

on dental visits, dental services, and coverage status. We selected these

 

6

Healthy People 2020 is an HHS initiative that provides science-based, 10-year national 

objectives for improving the health of all Americans. Healthy People establishes 

benchmarks and monitors progress over time in order to encourage collaborations across 

communities and sectors, empower individuals toward making informed health decisions, 

and measure the impact of prevention activities. See 

http://www.healthypeople.gov/about/default.aspx for more information.
 

Page 3 GAO-13-754 Dental Services Coverage and Payments

years for our analysis because 1996 was the first year MEPS was 

administered and 2010 was the most recent year for which data were 

available; we included 2004 to provide three points in time for our 

analysis. MEPS is administered by HHS’s Agency for Healthcare 

Research and Quality (AHRQ) and is a nationally representative survey of

the noninstitutionalized population, including families, medical providers, 

and employers across the United States. We based our analysis on a 

similar analysis conducted by AHRQ for its Chartbook 17 publication.7 We 

analyzed data on dental coverage and dental visits (including the 

category of service obtained during the visit, such as preventive or 

restorative) per year, as well as differences in coverage status and dental 

visits based on demographics such as age group and income level. We 

also examined use of dental services by individuals in urban and rural 

areas; to ensure adequate sample sizes, we combined several years of 

MEPS data. Information for the urban and rural analysis is presented in 

appendix II. MEPS collects information on private dental coverage but 

does not collect information specifically about whether dental coverage is 

included in health plans offered by public programs such as health 

coverage provided by the Department of Veterans Affairs (VA), 

Department of Defense (DOD), or Medicare Advantage.8

To identify trends in dental payments by individuals and other payers, that 

is, how much individuals paid out of pocket for dental care and how much 

dental insurers or other payers, such as Medicaid, paid for dental claims, 

we obtained and analyzed MEPS 1996, 2004, and 2010 data files on 

Therefore, we 

could not determine for this population whether those individuals had 

dental coverage, and we categorized that group as unknown.

 

7

Chartbook 17 examined MEPS data related to dental coverage, use, and payments in 

1996 and 2004. R.J. Manski and E. Brown, Dental Use, Expenses, Private Dental 

Coverage, and Changes, 1996 and 2004, MEPS Chartbook No.17 (Rockville, Md.: 

Agency for Healthcare Research and Quality, 2007). See 

http://www.meps.ahrq.gov/mepsweb/data_files/publications/cb17/cb17.pdf. 

8

Medicare Part A covers hospital and other inpatient stays. Medicare Part B is optional 

insurance and covers hospital outpatient, physician, and other services. Medicare 

beneficiaries have the option of obtaining coverage for Medicare Part A and B services 

from private health plans that participate in the Medicare Advantage program—also known 

as Medicare Part C. Medicare Advantage is a private plan alternative to traditional 

Medicare fee-for-service and may provide benefits, such as dental coverage, not included 

in traditional Medicare fee-for-service. In 2010, about 25 percent of Medicare beneficiaries 

were enrolled in Medicare Advantage plans.
 

Page 4 GAO-13-754 Dental Services Coverage and Payments

dental visits, payments, and coverage status.9

To determine the extent to which dental fees varied between and within 

certain communities, we analyzed dental claims data compiled by FAIR 

Health, Inc. as of January 2013,

In addition, we analyzed 

variances by demographic group, including age group and income level.

10 and obtained dental fee schedules from 

selected federally funded health centers. The FAIR Health dental data set 

contains over 140 million claims, including geozip data (the first 3 digits of 

a postal zip code11) and American Dental Association (ADA) Current 

Dental Terminology (CDT) billing codes.12 We selected 24 dental 

procedures for comparison by identifying the CDT billing codes with the 

most dental claims in each of six categories of dental services—five 

codes each for diagnostic, preventive, and restorative services; and three 

each for endodontic, periodontic, and oral surgery services. Academic 

experts and ADA officials agreed that our list of 24 CDT codes was 

representative of the most common dental procedures. To select large 

communities, we identified the geozip with the most dental claims in the 

core city in the largest metropolitan statistical area in each of the nine 

U.S. Census Bureau divisions.13

 

9

For this report, we refer to MEPS dental expenses as dental payments.

For comparison to our large 

communities, we selected nine small communities in the same states 

based on their population. Because geozip boundaries do not align with 

10FAIR Health, Inc., is an independent, not-for-profit corporation that compiles dental and 

medical claims data (nondiscounted fees charged by providers) from private insurers. See 

http://www.fairhealth.org/ for more information about FAIR Health, Inc., and its dental 

claims data set.

11FAIR Health uses the term geozip to refer to an area covered by the first 3 digits of a 

postal zip code. The U.S. Postal Service describes a 3-digit zip code as the area served 

by a sectional center facility, which is a processing and distribution center for all zip codes 

beginning with those 3 digits. Larger cities can include multiple 3-digit zip codes. For 

example, the Los Angeles/Long Beach metropolitan area includes geozips 900 to 912 

(excluding 909).

12Codes on Dental Procedure and Nomenclature are the intellectual property of the ADA 

as copyright owner.

13The U.S. Office of Management and Budget delineates metropolitan statistical areas 

according to published standards that are applied to Census Bureau data. The general 

concept of a metropolitan statistical area is that of a core area containing a substantial 

population nucleus, together with adjacent communities having a high degree of economic 

and social integration with that core. The Census Bureau has nine divisions: New 

England, Middle Atlantic, East North Central, West North Central, South Atlantic, East 

South Central, West South Central, Mountain, and Pacific.
 

Page 5 GAO-13-754 Dental Services Coverage and Payments

metropolitan statistical area designations, we selected one geozip (the 

one with the most dental claims) to represent each large and each small 

metropolitan area. We examined the 50th percentile dental fee and the 

95th percentile dental fee for each of our 24 CDT codes from a geozip in 

each large and small community.14

To determine the reliability of the MEPS, FAIR Health, and health center 

data, we reviewed related documentation, talked to agency officials and 

academic experts, and reviewed other studies that used the data to 

address similar research questions. We determined that the MEPS, FAIR 

Health, and health center data were sufficiently reliable for the purposes 

of our report.

To identify dental fees charged by 

federally funded health centers, we obtained documentation and met with 

officials from HHS’s Health Resources and Services Administration 

(HRSA), which administers the Health Center Program. HRSA provided a 

list of health centers that served residents of our 18 selected communities

and that provided dental services. We obtained full fee and sliding fee 

schedules from one health center that served each community, although 

some health centers did not provide or bill separately for all 24 

procedures.

We conducted this performance audit from October 2012 to September

2013 in accordance with generally accepted government auditing 

standards. Those standards require that we plan and perform the audit to 

obtain sufficient, appropriate evidence to provide a reasonable basis for 

our findings and conclusions based on our audit objectives. We believe 

that the evidence obtained provides a reasonable basis for our findings 

and conclusions based on our audit objectives. (For more information on 

our scope and methodology, see app. III.)

 

14Percentiles indicate the percentage of reported fees that are below the stated amount; 

for example, 95 percent of reported fees fall below the 95th percentile.
 

Page 6 GAO-13-754 Dental Services Coverage and Payments

Dental services cover an array of procedures, from preventive services, 

such as cleanings, to more complex services, such as root canals (see 

table 1).

Table 1: Categories and Examples of Dental Services

Category Examples

Diagnostic • X-ray

• Examination

Preventive • Cleaning

• Fluoride application

• Sealant application

Restorative • Fillings

• Crowns

Endodontic • Root canal

Periodontic • Treatment of the gums

Oral Surgery • Surgical removal of a tooth

Source: GAO summary of American Dental Association (ADA) information.

Most individuals with dental coverage have private dental insurance. 

Private dental insurance plans may be a stand-alone plan or be included 

as a part of medical insurance. Stand-alone dental plans require 

individuals to enroll separately; they are not a part of the individual’s 

medical insurance plan. The types of dental services covered by dental 

plans vary widely among private plans. For example, one plan may 

include “comprehensive” care such as routine diagnostic and preventive 

services, restorative services, and oral surgery, while another may cover 

more limited services such as emergency care only. Cost sharing for 

dental services usually involves an annual deductible—and according to a 

Bureau of Labor Statistics survey of employers, in 2008, the median 

deductible was $50 per person.15

 

15Bureau of Labor Statistics, Selected Medical Benefits: A Report from the Department of 

Labor to the Department of Health and Human Services (Washington, D.C.: Apr. 15, 

2011). This survey was conducted by the Bureau of Labor Statistics of employersponsored health plans to determine the benefits typically covered by employers.

After the individual meets the 

Background 

Dental Services

Dental Coverage
 

Page 7 GAO-13-754 Dental Services Coverage and Payments

deductible, dental plans may pay a percentage of covered services up to 

a maximum annual benefit. In 2008, the reported median annual 

maximum was $1,500.

Individuals may also obtain dental coverage in other ways, such as 

through federal programs. Federal programs may cover dental services 

as a required benefit, support purchase of stand-alone dental coverage 

for eligible beneficiaries, or support coverage of dental services as part of 

broader coverage under individuals’ medical coverage plans, for example. 

Benefits included in these types of coverage may vary widely depending 

on factors such as type of plan purchased, family income, or veteran’s 

status (see table 2).
 

Page 8 GAO-13-754 Dental Services Coverage and Payments

Table 2: Descriptions of Dental Coverage within Certain Federal Health Programs

Program Description of dental coverage

Medicaida For children in Medicaid, under the Early and Periodic Screening, Diagnostic, and 

Treatment benefit, state Medicaid programs must provide dental services, including 

diagnostic, preventive, and related treatment services, for all eligible Medicaid 

beneficiaries under age 21. For adults in Medicaid, dental coverage varies, as states have 

flexibility to determine whether to provide dental benefits for adults and if so, what 

services to include. For example, while many states cover some dental services for 

adults, such as preventive exams, other states do not, limiting this benefit to trauma care 

or emergency treatment for pain relief and infection. States may also require that certain 

services have prior approval, or place limits on the total amount of services an enrollee 

can receive each year.

and State Children’s Health 

Insurance Program (CHIP)

When CHIP was established in 1997, coverage of dental services was not a required 

benefit.b The Children’s Health Insurance Program Reauthorization Act of 2009 expanded 

federal requirements for CHIP programs to cover dental services.c

Medicare

Specifically, the act 

required states to cover dental services in their CHIP programs beginning in October 

2009. It also gave states authority to use benchmark plans to define the benefit package 

or to supplement children’s private health insurance with a dental coverage plan financed 

through CHIP. States that provide CHIP coverage to children through a Medicaid 

expansion program are required to provide the Early and Periodic Screening, Diagnostic, 

and Treatment benefit. States with a separate CHIP program may choose from two 

options for providing dental coverage: a package of dental benefits that meets the CHIP 

requirements, or a benchmark dental benefit package that is substantially equal to the 

(1) most popular federal employee dental plan for dependents, (2) most popular plan 

selected for dependents in the state’s employee dental plan, or (3) dental coverage 

offered through the most popular commercial insurer in the state. 

Generally, Medicare does not cover routine preventive or restorative dental services. 

Medicare fee-for-service offers dental coverage under limited circumstances, for example, 

providing dental services that are an integral part of a covered procedure 

(e.g., reconstruction of the jaw following accidental injury). Medicare Advantage plans 

have the flexibility to offer coverage of routine preventive and restorative dental services. 

Medicare dental coverage varies by type of Medicare Advantage plan selected by 

beneficiaries.

Department of Veterans Affairs (VA)

d

VA coverage of dental services requires enrollment, and exact coverage of dental 

services varies by an individual veteran’s status—for example, whether the veteran has a 

service-connected disability. In some instances, VA may provide comprehensive dental 

care, while in other cases covered dental services may be limited. For example, some 

veterans with service-connected disabilities are eligible for any necessary dental care. 

Other veterans are only eligible for dental care if their dental problems may complicate 

existing medical conditions.

Department of Defense TRICARE TRICARE—the Department of Defense’s regionally structured health care system—offers 

dental benefits as a separate program that for many beneficiaries requires separate 

enrollment. The TRICARE Dental Program and TRICARE Retiree Dental Program are 

voluntary and require enrollment. The TRICARE Active Duty Dental Program supplements 

services provided at military dental treatment facilities for active duty service members. 

Benefits vary by program and eligibility—for example, families may have to purchase a 

supplemental dental policy outside of their medical coverage to obtain dental coverage.

Source: GAO summary of agency information.

a

Medicaid, a joint federal and state program that provides health care coverage for certain low-income 

individuals and families, provided health coverage for an estimated 70 million enrollees in fiscal year 
 

Page 9 GAO-13-754 Dental Services Coverage and Payments

2011. States operate their Medicaid programs within broad federal requirements and may contract 

with managed care organizations to provide Medicaid medical and dental benefits.

b

States can administer their CHIP programs as (1) an expansion of their Medicaid program, (2) a 

stand-alone program, or (3) a combination of Medicaid expansion and stand-alone.

c

Pub. L. No. 111-3, § 501, 123 Stat. 8, 84.

d

Medicare Part A covers hospital and other inpatient stays. Medicare Part B is optional insurance and 

covers hospital outpatient, physician, and other services. Medicare beneficiaries have the option of 

obtaining coverage for Medicare Part A and B services from private health plans that participate in the 

Medicare Advantage program—also known as Medicare Part C. In 2010, about 25 percent of 

Medicare beneficiaries were enrolled in Medicare Advantage plans. Medicare Advantage is a private 

plan alternative to traditional Medicare fee-for-service and may provide benefits, such as dental 

coverage, not included in traditional Medicare fee-for-service.

HHS’s HRSA reported that in 2011, over 4 million patients used dental 

services at federally funded health centers.16

A health center must establish a fee schedule for its services that is 

consistent with locally prevailing rates and reflects the health center’s 

reasonable costs of providing services. A health center must also 

establish a sliding fee schedule for individuals who earn annual incomes 

equal to or less than 200 percent of the FPL.

Under the Health Center 

Program, health centers—which must be located in federally designated 

medically underserved areas or serve a federally designated medically 

underserved population—are required to provide pediatric dental 

screenings and preventive dental services, as well as emergency medical 

referrals, which may also result in the provision of dental services. Health 

centers may provide required services, including required dental services,

directly or via formal contract or referral agreements. However, health 

centers are not required to provide a full range of dental services.

17 HRSA reported that in 

2011, over 92 percent of the more than 20 million patients served by 

health centers nationwide had income less than or equal to 200 percent 

of the FPL (and were eligible for a sliding scale fee based on income and 

family size).18

 

1642 U.S.C. § 254b. Health centers are funded in part through grants under the Health 

Center Program—administered by HRSA—and provide comprehensive primary care 

services for the medically underserved.

17The 2013 federal poverty guidelines state that a family of four at 200 percent of the 

poverty level has an income of $47,100 per year.

18According to HRSA officials, data specific to dental patients were not available.

Dental Care Provided by 

Health Centers
 

Page 10 GAO-13-754 Dental Services Coverage and Payments

The Patient Protection and Affordable Care Act (PPACA) has designated 

pediatric dental care as an essential health benefit that new health plans 

must cover in the new health care exchanges and the small-group and 

individual markets. Exchanges may allow plans to offer stand-alone 

dental coverage providing, at a minimum, pediatric dental care. Adult 

dental coverage is not included as an essential health benefit. Plans that 

have grandfathered status under the law are not required to offer pediatric 

dental coverage.19 PPACA has the potential to change the benefits and 

out-of-pocket payments associated with dental coverage; however, the 

extent of these changes is uncertain.

The rate of individuals with dental coverage remained largely unchanged 

from 1996 to 2010; around 62 to 63 percent of the population had private 

or Medicaid or CHIP dental coverage. In addition, from 1996 to 2010, the 

percentage of individuals who had a dental visit remained about the 

same, around 41 to 43 percent.

Our analysis of MEPS data showed that overall, the rate of dental 

coverage—the percentage of individuals reporting that they had dental 

coverage through private insurance or Medicaid or CHIP—remained 

relatively unchanged from 1996 to 2010.20

 

19Private health care plans in existence as of March 23, 2010, are considered 

grandfathered plans that do not have to comply with certain PPACA coverage 

requirements. However, plans may lose their grandfathered status if they cut benefits or 

increase beneficiary cost sharing.

Specifically, in 1996, 

62 percent of individuals reported having dental coverage, and in 2010, 

63 percent reported having dental coverage. For about 10 to 12 percent 

20For purposes of this report, we refer to children in Medicaid and CHIP as children in 

Medicaid, because the MEPS data do not distinguish between children in Medicaid and 

CHIP.

Dental Care under the 

Patient Protection and 

Affordable Care Act

National Survey Data 

Show That Rates of 

Dental Coverage and 

Use of Dental 

Services Remained 

Generally Unchanged 

from 1996 to 2010

Coverage of Dental 

Services Remained 

Relatively Unchanged from 

1996 to 2010
 

Page 11 GAO-13-754 Dental Services Coverage and Payments

of the population, including many individuals covered by Medicare and 

other federal health programs, dental coverage status is unknown.21

While the overall percentage of individuals with dental coverage generally 

stayed the same between 1996 and 2010, the percentages with private 

dental and without insurance coverage decreased and the percentage 

with Medicaid dental coverage increased. Specifically, the percentage of 

individuals with private coverage was 53 percent in 1996 and 50 percent 

in 2010 (see fig. 1). The percentage of individuals with dental coverage 

under Medicaid increased steadily in each of the years we examined, 

from 9 percent in 1996 to 13 percent in 2010. The percentage of 

individuals reporting that they did not have dental coverage decreased 

from 28 percent in 1996 to 25 percent in 2010, leaving at least one in four 

individuals with no dental coverage—approximately 76 million people—in 

2010. For 10 to 12 percent of individuals in each year we examined, it is 

unknown whether they had dental coverage. These individuals reported 

having some type of health coverage, such as Medicare coverage, but 

the MEPS survey structure did not allow us to determine whether that 

health coverage included dental coverage.

 

21Most of these individuals reported having Medicare coverage. Traditional Medicare 

offers very limited dental benefits. Medicare Advantage plans may include dental 

coverage. In 2010, about 25 percent of Medicare beneficiaries were in a Medicare 

Advantage plan, but not all plans offer dental coverage or offer dental coverage as an 

optional benefit. Consequently, this conservative approach may result in overstating the 

“unknown” category and understating the “none” category.
 

Page 12 GAO-13-754 Dental Services Coverage and Payments

Figure 1: Dental Coverage Status, 1996, 2004, and 2010

Notes: Data are from the Medical Expenditure Panel Survey (MEPS). This figure includes only the 

noninstitutionalized population. For 2004 and 2010, Medicaid includes children enrolled in the State 

Children’s Health Insurance Program.

Individuals in the unknown category indicated that they had other types of public coverage, including 

state or federal programs such as Medicare or veteran’s benefits. These programs might not have

included dental coverage, or might have provided limited dental coverage to certain individuals. For 

these programs, the MEPS survey methodology did not allow us to identify which beneficiaries 

actually had dental coverage. Beneficiaries in these programs with a dental claim paid by private 

insurance during the period were counted as having private coverage. For example, Medicare 

Advantage enrollees who had a claim paid by private insurance were counted in the private insurance 

category. Medicare beneficiaries who did not have a claim paid by private insurance were included in 

the unknown category because they might have had dental coverage, such as under a Medicare 

Advantage plan, but did not use their coverage during the survey period.

Rates of private dental coverage among individuals in the high-income 

category (over 400 percent of FPL) were higher than any other income 

category in 1996, 2004 and 2010 (see fig. 2). Individuals in the poor-, 

low-, and middle-income groups saw a decline in the rates of private 

coverage over the same period.22

 

22For this analysis, poor individuals are individuals in families with income at or below 

100 percent of the FPL. The low-income group is individuals in families with income at or 

below 200 percent of the FPL but above 100 percent of the FPL. Individuals in the 

middle-income group are those in families with income at or below 400 percent of the FPL, 

but above 200 percent of the FPL.
 

Page 13 GAO-13-754 Dental Services Coverage and Payments

Figure 2: Rates of Private Dental Coverage, by Income Level, 1996, 2004, and 2010

Notes: Data are from the Medical Expenditure Panel Survey (MEPS). This figure includes only the 

noninstitutionalized population. Income is expressed in terms of poverty status. For this analysis, poor 

refers to individuals in families with income at or below 100 percent of the federal poverty level (FPL). 

The low-income group is individuals in families with income at or below 200 percent of the FPL but 

above 100 percent of the FPL. The middle-income group is individuals in families with income at or 

below 400 percent of the FPL but above 200 percent of the FPL. The high-income group is individuals 

in families with income greater than 400 percent of the FPL.

The percentage of individuals with Medicaid dental coverage 

increased from 9 percent in 1996 to 13 percent in 2010. This trend was 

largely driven by an increase in children covered by Medicaid, which 

requires pediatric dental coverage. The overall percentage of children 

(ages 0-20 years) reported to have dental coverage—through private 

coverage or Medicaid—increased from 72 percent (59 million) in 1996 to 

81 percent (71 million) in 2010, and fewer children were uninsured, 

because more children were covered by Medicaid in 2010 than in prior 

years. The percentage of children with dental coverage through Medicaid 

increased from 18 percent (15 million) in 1996 to 33 percent (29 million) in 

2010 (see fig. 3). This was the largest increase in coverage for any age 

group in Medicaid. The percentage of children with private dental 
 

Page 14 GAO-13-754 Dental Services Coverage and Payments

coverage decreased from 54 percent (44 million) in 1996 to 48 percent 

(42 million) in 2010. In addition, rates of children without dental coverage 

declined from 27 percent (22 million) to 17 percent (15 million) over the 

same period.

Figure 3: Dental Coverage Rates for Children, Ages 0-20 Years, 1996, 2004, and 

2010

Notes: Data are from the Medical Expenditure Panel Survey (MEPS). This figure includes only the 

noninstitutionalized population. The unknown category for this age group is not reported in this figure 

because of small sample sizes (fewer than 2 percent of children ages 0-20 years were reported as 

having unknown dental coverage). For 2004 and 2010, Medicaid includes children enrolled in the 

State Children’s Health Insurance Program.

The percentage of individuals who used dental services—those who 

reported having at least one dental visit during the year—remained 

relatively unchanged at around 40 percent from 1996 to 2010. 

Specifically, about 43 percent of individuals in 1996 and 41 percent in 

2010 had a dental visit. Table 3 shows our analysis of MEPS data on the 

use of dental services.

Use of Dental Services 

Remained Relatively 

Unchanged from 1996 to 

2010
 

Page 15 GAO-13-754 Dental Services Coverage and Payments

Table 3: Percentage of Individuals with a Dental Visit, 1996, 2004, and 2010

1996 2004 2010

Dental visit 42.9 43.6 41.3

No dental visit 57.1 56.4 58.7

Total 100.0 100.0 100.0

Source: GAO analysis of HHS data.

Notes: Data are from the Medical Expenditure Panel Survey (MEPS). This table includes only the 

noninstitutionalized population.

Trends in dental visits by individuals with private dental coverage largely 

explained why the percentage of individuals with a dental visit remained 

relatively unchanged from 1996 to 2010. Specifically, over this period the 

percentage of individuals with private dental coverage who had a dental 

visit remained the same, at around 56 percent (see table 4), and 

individuals with private coverage made up a large majority—around 80 to 

85 percent—of the population with dental coverage during that time 

period. The number of individuals without dental coverage who had a 

dental visit declined—from 26 percent, or 19 million individuals, in 1996 to 

18 percent, or 14 million individuals, in 2010.

Table 4: Percentage of Individuals with a Dental Visit, by Coverage Status, 1996, 

2004, and 2010

1996 2004 2010

Private 56.4 57.3 56.9

Medicaid 27.7 31.6 33.6

Unknown 33.5 a 34.8 31.8

None 25.8 21.7 18.0

Source: GAO analysis of HHS data.

Notes: Data are from the Medical Expenditure Panel Survey (MEPS). This table includes only the 

noninstitutionalized population with a dental visit. For 2004 and 2010, Medicaid includes children 

enrolled in the State Children’s Health Insurance Program.

a

Individuals in the unknown category indicated that they had other types of public medical coverage, 

including state or federal programs such as Medicare or veteran’s benefits. These programs might 

not have included dental coverage, or might have provided limited dental coverage to certain 

individuals. For these programs, the MEPS survey methodology did not allow us to identify which 

beneficiaries actually had dental coverage. Beneficiaries in these programs with a dental claim paid 

by insurance during the period were counted as having private coverage. For example, Medicare 

Advantage enrollees who had a claim paid by private insurance were counted in the private insurance 

category. Medicare beneficiaries who did not have a claim paid by insurance were included in the 

unknown category because they might have had dental coverage such as under a Medicare 

Advantage plan, but did not use their coverage during the survey period.
 

Page 16 GAO-13-754 Dental Services Coverage and Payments

The percentage of individuals with Medicaid who had a dental visit 

increased from 1996 to 2010. This increase reflects an increase in the 

number of children with Medicaid coverage who had a dental visit, 

although these children still had dental visits at lower rates than privately 

insured children (58 percent). The percentage of children with Medicaid 

dental coverage with a dental visit increased from 28 percent, or 4 million 

children, in 1996 to 37 percent, or 11 million children, in 2010. (See 

fig. 4.)

Figure 4: Percentage of Children, Ages 0-20 Years, with Private and Medicaid Dental 

Coverage with a Dental Visit, 1996, 2004, and 2010

Notes: Data are from the Medical Expenditure Panel Survey (MEPS). This figure includes the 

noninstitutionalized population with a dental visit. From 1996 to 2010, 72 percent to 81 percent of 

children ages 0-20 years had private or Medicaid dental coverage. For 2004 and 2010, Medicaid 

includes children enrolled in the State Children’s Health Insurance Program.

Among individuals who reported having a dental visit, there was an 

increase in the percentage reporting that they received diagnostic and 

preventive services (for example, exams and cleanings) and a decrease 

in those reporting that they received other services, such as restorative 

services (for example, fillings), from 1996 to 2010. Specifically, the 

percentage of visits for diagnostic and preventive services as a proportion 
 

Page 17 GAO-13-754 Dental Services Coverage and Payments

of total dental services increased (see fig. 5). Seventy-six percent of 

dental visits in 2010 consisted of diagnostic or preventive services (43 

and 33 percent, respectively). This is an increase from 69 percent in 

1996, when diagnostic and preventive services made up 40 and 29 

percent of services received, respectively. The percentage of visits for 

other types of services decreased from 1996 to 2010. Specifically, 

restorative services—such as fillings—decreased slightly from 8 percent 

to 6 percent as a proportion of total dental services received in those 

years. Other services that decreased included prosthetic and orthodontic 

services. 

Figure 5: Types of Dental Services as a Proportion of Total Services, 1996, 2004, and 2010

Notes: Data are from the Medical Expenditure Panel Survey (MEPS). This figure includes only the 

noninstitutionalized population and presents the percentage of visits that were for each category of 

dental procedure.

The “other” category includes treatment for temporomandibular joint and muscle disorders (jaw pain), 

bonding, whitening or bleaching, as well as periodontic, prosthetic, orthodontic, oral surgery, and 

endodontic services.
 

Page 18 GAO-13-754 Dental Services Coverage and Payments

Average annual payments made on behalf of or by individuals for dental 

services—including payments from other payers such as insurers and 

out-of-pocket payments—increased from 1996 to 2010.23

Table 5: Average Annual Dental Payments for Individuals with a Dental Visit, 

Adjusted for Inflation, by Coverage Status, 1996, 2004, and 2010

Average annual 

inflation-adjusted dental payments increased 26 percent from $520 per 

year in 1996 to $653 per year in 2010 (see table 5). The average annual 

payments made—including out-of-pocket payments and payments by 

other payers—increased 24 percent for the privately insured, 39 percent 

for individuals with Medicaid, and 38 percent for those without dental 

coverage. In addition, in 2010, average annual dental payments (out of 

pocket and payments made by other payers) for those with private 

coverage were nearly twice as much as the payments made by and on 

behalf of individuals with Medicaid coverage.

1996 2004 2010

Average payment $520 $647 $653

Private 580 713 719

Medicaid 269 356 373

Unknown — a 623 630

None 406 528 561

Source: GAO analysis of HHS data.

Notes: Data are from the Medical Expenditure Panel Survey (MEPS). This table includes only the 

noninstitutionalized population with a dental visit. In MEPS, payments are defined as the sum of 

payments for care received, including out-of-pocket payments and payments made by private 

insurance, Medicaid, Medicare, and other payers. Payments were adjusted for inflation using the 

Consumer Price Index for All Urban Consumers (CPI-U), 2010 dollars. Dashes indicate the sample 

size was too small for a reliable estimate. For 2004 and 2010, Medicaid includes children enrolled in 

the State Children’s Health Insurance Program.

a

 

23In MEPS, payments are defined as the sum of payments for care received, including 

out-of-pocket payments and payments made by private insurance, Medicaid, and other 

payers. They do not include premium costs. Payments were adjusted for inflation using 

the Consumer Price Index for All Urban Consumers (CPI-U), 2010 dollars. 

Individuals in the unknown category indicated that they had other types of public medical coverage, 

including state or federal programs such as Medicare or veteran’s benefits. These programs might 

not have included dental coverage, or might have provided limited dental coverage to certain 

individuals. For these programs, the MEPS survey methodology did not allow us to identify which 

beneficiaries actually had dental coverage. Beneficiaries in these programs with a dental claim paid 

by insurance during the period were counted as having private coverage. For example, Medicare 

Advantage enrollees who had a claim paid by private insurance were counted in the private insurance 

category. Medicare beneficiaries who did not have a claim paid by insurance were included in the 

unknown category because they might have had dental coverage such as under a Medicare 

Advantage plan, but did not use their coverage during the survey period.

Average Payments for 

Dental Services 

Increased from 1996 

to 2010
 

Page 19 GAO-13-754 Dental Services Coverage and Payments

Average annual payments for dental services varied across income 

levels. Payments made by and on behalf of individuals in the low-, and 

middle-income groups increased steadily from 1996 to 2010. However, 

average annual payments made by and on behalf of individuals who were 

poor increased from $373 in 1996 to $493 in 2004, and then decreased to 

$437 in 2010.24 For low-income individuals, that is, individuals with 

incomes at or below 200 percent but above 100 percent of the FPL, 

dental payments had the largest increase. Specifically, average annual 

dental payments for the low-income group increased from $393 in 1996 to 

$558 in 2010 (see fig. 6), about 42 percent. Average annual dental 

payments also increased for middle- and high-income individuals—23 

and 25 percent, respectively.

 

24Poor includes individuals in families with income at or below 100 percent of the FPL.
 

Page 20 GAO-13-754 Dental Services Coverage and Payments

Figure 6: Average Annual Payments for Dental Services for Individuals with a 

Dental Visit, Adjusted for Inflation, by Income Level, 1996, 2004, and 2010

Notes: Data are from the Medical Expenditure Panel Survey (MEPS). This figure includes only the 

noninstitutionalized population with a dental visit. In MEPS, payments are defined as the sum of 

payments for care received, including out-of-pocket payments and payments made by private 

insurance, Medicaid, Medicare, and other sources. Payments were adjusted for inflation using the 

Consumer Price Index for All Urban Consumers (CPI-U), 2010 dollars.

For this analysis, poor are individuals in families with income at or below 100 percent of the federal 

poverty level (FPL). The low income group is individuals in families with incomes at or below 

200 percent of the FPL but above 100 percent of the FPL. The middle-income group is individuals in 

families with income at or below 400 percent of the FPL but above 200 percent of the FPL. The highincome group is individuals in families with income greater than 400 percent of the FPL.

Individuals’ out-of-pocket payments for dental services, separate from 

payments by other payers, when adjusted for inflation, generally 

increased from 1996 to 2010 (see fig. 7). Specifically, average annual 

out-of-pocket payments made by individuals with private coverage 

increased 21 percent from 1996 to 2010—from $242 to $294. Individuals 

with no dental coverage experienced the greatest increase in average 

annual out-of-pocket payments, from $392 to $518, a 32 percent 

increase. For individuals with Medicaid coverage, their average annual 
 

Page 21 GAO-13-754 Dental Services Coverage and Payments

out-of-pocket payments remained relatively unchanged, $64 in 1996 and 

$59 in 2010.25

Figure 7: Average Annual Out-of-Pocket Payments for Individuals with a Dental 

Visit, 1996, 2004, and 2010

Notes: Data are from Medical Expenditure Panel Survey (MEPS). This table includes only the 

noninstitutionalized population with a dental visit. Payments were adjusted for inflation using the 

Consumer Price Index for All Urban Consumers (CPI-U), 2010 dollars. For 2004 and 2010, Medicaid 

includes children enrolled in the State Children’s Health Insurance Program.

The out-of-pocket payments for individuals in the unknown group are not reported in the figure 

because of sample size concerns and high relative standard errors in the estimate. Relative standard 

error is the proportion of the standard error divided by the estimate itself.

 

25Cost sharing in Medicaid for most services is limited to nominal amounts. See 

http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/CostSharing/Cost-Sharing.html (accessed May 24, 2013).
 

Page 22 GAO-13-754 Dental Services Coverage and Payments

Dental fees charged by dentists and health centers varied across 

geographic areas and within communities. For 24 common dental 

procedures, dental fees charged by local dentists varied significantly 

between the 18 communities we examined. In addition, dental fees varied 

widely within communities. Dental fees also varied between local dentists 

and health centers that serve residents of the same community, but all 

health centers are required to offer sliding fee schedules for low-income 

individuals.

For 24 common dental procedures, midpoint dental fees—the amount 

where half of fees charged were higher and half were lower—varied 

widely between the 18 communities we examined.26

 

26We analyzed dental insurance claims data in nine states corresponding to the nine U.S. 

Census divisions. Using 2010 Census data, we selected two communities in each state, 

one large, based on their population and volume of dental claims and one small based on 

population. Our nine selected community pairs, large and small (with selected geozip), 

were Phoenix (850) and Flagstaff (860), Arizona; Los Angeles (900) and Fresno (936), 

California; Miami (331) and Palm Coast (321), Florida; Chicago (606) and Champaign 

(618), Illinois; Boston (021) and Pittsfield (012), Massachusetts; Minneapolis (554) and 

Mankato (560), Minnesota; New York (100) and Elmira (148), New York; Nashville (372) 

and Jackson (382), Tennessee; and Dallas (752) and San Angelo (768), Texas. (See 

app. III for more information on our scope and methodology.)

For example, 

midpoint dental fees for an adult prophylaxis (commonly called teeth 

cleaning) in large communities ranged from $76 in Nashville, Tennessee, 

to $155 in New York, New York. In smaller communities, midpoint fees 

ranged from $59 in Jackson, Tennessee, to $88 in Fresno, California (see 

fig. 8). Similarly, midpoint fees charged for a child prophylaxis ranged 

from $55 to $105 in large communities and $48 to $71 in small 

communities. Dental fees, as with other health care costs, vary by 

location. (See tables 10 to 27 in app. IV for more information on the range 

of dental fees for other common dental procedures in selected 

communities.)

Fees Charged for 

Dental Services 

Varied between and 

within Communities

Dental Fees Varied Widely 

between Communities
 

Page 23 GAO-13-754 Dental Services Coverage and Payments

Figure 8: Midpoint Dental Fees in 18 Communities for Teeth Cleaning (Adult and Child), 2012

Note: Fees are reported for Current Dental Terminology (CDT) codes D1110: Prophylaxis (Adult) and 

D1120: Prophylaxis (Child). The American Dental Association describes prophylaxis (commonly 

called teeth cleaning) as removal of plaque, calculus, and stains from the tooth structures in the 

permanent and transitional dentition.

Several factors can contribute to geographic variation in dental fees, 

including local wages and the cost of space and equipment needed to 

operate a practice. Although we identified no current peer-reviewed 

research that established a correlation between individual factors and the 

level of dental fees, geographic variation in spending for medical services 
 

Page 24 GAO-13-754 Dental Services Coverage and Payments

is well documented. For example, the Congressional Budget Office 

reported that a number of factors, including facilities, supplies, and 

wages, influence geographic variation in health care spending.27 The 

Centers for Medicare & Medicaid Services (CMS), in setting Medicare 

payment rates for health care services, establishes a geographic practice 

cost index for each Medicare payment locality to account for variation in 

practice expenses. CMS reported that it did not have any comparable 

practice cost index for Medicaid dental fees.

Dental claims data also showed significant differences within communities 

for all 24 common dental procedures we examined. Fees within the 

private practice dental setting are affected by local market conditions and 

decisions within the individually owned practices. FAIR Health dental 

claims data showed that within communities the difference between 

midpoint and upper-end fees was as high as 143 percent for localized 

delivery of antimicrobial agents. Upper-end fees were at least double the 

midpoint fees in at least one community for 8 of the 24 common 

procedures we examined (see table 6). (See app. IV for information on all 

24 procedures in all 18 selected communities.)

 

27Congressional Budget Office, Geographic Variation in Health Care Spending, Pub. 

No. 2978 (Washington, D.C.: Feb. 2008). 

Dental Fees Varied Widely 

within Communities
 

Page 25 GAO-13-754 Dental Services Coverage and Payments

Table 6: Procedures with the Largest Percentage Difference between Midpoint and Upper-End Fees, 2012

Current Dental 

Terminology 

(CDT) code Description Community (geozip) Midpoint fee Upper-end fee

Percentage 

difference 

D4381 Localized Delivery of Antimicrobial 

Agents via a Controlled Release Vehicle 

Into Diseased Crevicular Tissue, per 

Tooth, by Report

Los Angeles, Calif. (900) $80 $194 143%

D0120 Periodic Oral Evaluation – Established 

Patient

Miami, Fla. (331) 62 150 142

D0230 Radiographs/Diagnostic Imaging:

Intraoral – Periapical Each Additional 

Film

New York, N.Y. (100) 21 50 138

D1203 Topical Application of Fluoride – Child Los Angeles, Calif. 

(900)

40 90 125

D0274 Radiographs/Diagnostic Imaging:

Bitewings – Four Films

Miami, Fla. (331) 66 140 112

D7140 Extraction, Erupted Tooth or Exposed 

Root (Elevation and/or Forceps Removal)

New York, N.Y. (100) 290 600 107

D0220 Radiographs/Diagnostic Imaging:

Intraoral – Periapical First Film

Miami, Fla. (331) 25 50 100

D1204 Topical Application of Fluoride – Adult Los Angeles, Calif. (900) 40 80 100

Source: GAO analysis of FAIR Health data (as of January 2013). American Dental Association (ADA) CDT definitions.

Note: Midpoint fees are the 50th percentile and upper-end fees are the 95th percentile (percentiles 

indicate the percentage of reported fees that are below the stated amount; for example, 95 percent of 

reported fees fall below the 95th

Dental fees within communities also varied widely for diagnostic 

procedures. For the most common diagnostic procedure, a periodic oral 

evaluation of an established patient, the percentage difference between 

reported midpoint and upper-end fees in large communities ranged from 

20 percent to 142 percent (see table 7). For example, in Miami, Florida, 

half of the fees charged by dentists for a periodic oral examination of an 

established patient were $62 or less, but 5 percent of fees charged for 

that procedure were $150 or more, a 142 percent difference. In small 

communities, the percentage difference was less, ranging from 

17 percent to 58 percent.

percentile).
 

Page 26 GAO-13-754 Dental Services Coverage and Payments

Table 7: Differences between Midpoint and Upper-End Dental Fees Charged for a 

Periodic Oral Evaluation of an Established Patient, by Local Dentists in 18 

Communities in Nine States, 2012 

Community (geozip) Midpoint fee Upper-end fee Percentage difference

Large communities

Miami, Fla. (331) $62 $150 142%

New York, N.Y. (100) 80 152 90

Los Angeles, Calif. (900) 63 110 75

Chicago, Ill. (606) 49 72 47

Phoenix, Ariz. (850) 45 62 38

Nashville, Tenn. (372) 42 57 36

Boston, Mass. (021) 49 65 33

Dallas, Tex. (752) 47 61 30

Minneapolis, Minn. (554) 50 60 20

Small communities

San Angelo, Tex. (768) $38 $60 58

Fresno, Calif. (936) 45 66 47

Jackson, Tenn. (382) 33 45 36

Palm Coast, Fla. (321) 36 49 36

Pittsfield, Mass. (012) 36 47 31

Elmira, N.Y. (148) 40 52 30

Champaign, Ill. (618) 40 50 25

Mankato, Minn. (560) 41 48 17

Flagstaff, Ariz. (860) 47 55 17

Source: GAO analysis of FAIR Health data (as of January 2013). American Dental Association (ADA) Current Dental Terminology 

(CDT) definitions.

Notes: Fees are reported for CDT code D0120: Periodic Oral Evaluation (Established Patient). ADA 

describes this procedure as an evaluation performed on a patient of record to determine any changes 

in the patient’s dental and medical health status since a previous comprehensive or periodic 

evaluation. This includes an oral cancer evaluation and periodontal screening where indicated, and 

may require interpretation of information acquired through additional diagnostic procedures.

Midpoint fees are the 50th percentile and upper-end fees are the 95th percentile (percentiles indicate 

the percentage of reported fees that are below the stated amount; for example, 95 percent of reported 

fees fall below the 95th

Dental fees within communities also varied widely for restorative 

procedures. For the most common restorative procedure, a filling, the 

percentage difference between reported midpoint and upper-end fees in 

large communities ranged from 19 percent to 67 percent (see table 8). 

For example, in Phoenix, Arizona, half of the fees charged by dentists for 

a filling were $195 or less, but 5 percent of fees charged for that 

procedure were $325 or more, a 67 percent difference. In small 

percentile).
 

Page 27 GAO-13-754 Dental Services Coverage and Payments

communities, the percentage difference was smaller, ranging from 

13 percent to 38 percent.

Table 8: Differences between Midpoint and Upper-End Dental Fees Charged for a 

Filling by Local Dentists in 18 Communities in Nine States, 2012

Community (geozip) Midpoint fee Upper-end fee Percentage difference

Large communities

Phoenix, Ariz. (850) $195 $325 67%

Miami, Fla. (331) 200 320 60

Dallas, Tex. (752) 189 294 56

Los Angeles, Calif. (900) 237 365 54

New York, N.Y. (100) 300 450 50

Nashville, Tenn. (372) 200 287 44

Chicago, Ill. (606) 205 290 41

Boston, Mass. (021) 225 301 34

Minneapolis, Minn. (554) 244 290 19

Small communities

Fresno, Calif. (936) $208 $288 38

Pittsfield, Mass. (012) 179 242 35

San Angelo, Tex. (768) 180 242 34

Palm Coast, Fla. (321) 175 231 32

Flagstaff, Ariz. (860) 206 266 29

Elmira, N.Y. (148) 179 230 28

Mankato, Minn. (560) 194 243 25

Jackson, Tenn. (382) 160 191 19

Champaign, Ill. (618) 208 235 13

Source: GAO analysis of FAIR Health data (as of January 2013). American Dental Association (ADA) Current Dental Terminology 

(CDT) definitions.

Notes: Fees are reported for CDT code D2392: Resin-Based Composite (Two Surfaces, Posterior). 

According to ADA, a resin-based composite refers to a broad category of materials including, but not 

limited to, composites. May include bonded composite, light-cured composite, etc. Tooth preparation, 

acid etching, adhesives (including resin-bonding agents), liners and bases and curing are included as 

part of the restoration.

Midpoint fees are the 50th percentile and upper-end fees are the 95th percentile (percentiles indicate 

the percentage of reported fees that are below the stated amount; for example, 95 percent of reported 

fees fall below the 95th percentile).
 

Page 28 GAO-13-754 Dental Services Coverage and Payments

Dental fees also varied between midpoint fees of local dentists billing 

private insurers and the full fees of the federally funded health centers 

that serve residents of the same community.28 In the 18 communities we 

examined, full dental fees for a tooth extraction (the most common oral 

surgery procedure) were typically lower at health centers. For patients 

with incomes at or below 100 percent of the FPL, 10 health centers 

offered a 100 percent fee discount and 8 health centers had fees ranging 

from $16 to $148 for extracting a tooth (see table 9). Health centers’ full 

fees—which fewer than 8 percent of health center patients pay—were 

often, but not always, lower than the midpoint fees charged by local 

dentists. In some cases, midpoint fees charged by local dentists were 

higher than health center fees by a wide margin. For example, in Los 

Angeles, the midpoint fee charged by local dentists for a tooth extraction 

was nearly 3 times the full fee charged by a health center serving 

residents of the same community. In other cases, full fees were higher 

than those of local dentists. For example, in Fresno the health center’s full 

fee was $177 for a tooth extraction compared to the midpoint fee charged 

by local dentists of $142. (See app. IV for additional information on local 

dentist fees and health center dental fees.)

 

28For families that cannot afford the prevailing cost of dental care, many obtain dental care 

from federally funded health centers. Dental services provided at health centers are 

available to all patients, regardless of their ability to pay, and in general, health centers 

must offer discounted fees for families with incomes at or below 200 percent of the FPL.
 

Page 29 GAO-13-754 Dental Services Coverage and Payments

Table 9: Dental Fees Charged for a Tooth Extraction by Local Dentists and Health 

Centers in 18 Communities in Nine States, 2012 

Health centers

Community (geozip)

b

Local dentists’ 

midpoint feea Full fee

100% of federal 

poverty level (FPL)

Large communities

New York, N.Y. (100) $290 $229 $36

Boston, Mass. (021) 175 157 0 

Minneapolis, Minn. (554) 167 147 0 

Miami, Fla. (331) 165 166 70

Los Angeles, Calif. (900) 157 54 0 

Dallas, Tex. (752) 152 159 16

Chicago, Ill. (606) 150 105 0 

Phoenix, Ariz. (850) 125 132 35

Nashville, Tenn. (372) 125 70 0 

Small communities

Champaign, Ill. (618) $159 $106

Pittsfield, Mass. (012)

c

153 145 0 

Flagstaff, Ariz. (860) 149 179 90

Elmira, N.Y. (148) 143 122 0 

Fresno, Calif. (936) 142 177 0 

San Angelo, Tex. (768) 137 148 148

Palm Coast, Fla. (321)

d

135 134 0 

Mankato, Minn. (560) 132 122 0 

Jackson, Tenn. (382) 97 e

Source: GAO analysis of FAIR Health and health center data (as of January 2013). American Dental Association (ADA) Current Dental 

Terminology (CDT) definitions.

f

Note: Fees are reported for CDT code D7140: Extraction, Erupted Tooth or Exposed Root (Elevation 

and/or Forceps Removal). ADA describes this procedure as including routine removal of tooth 

structure, minor smoothing of socket bone, and closure, as necessary.

a

Midpoint fees are the 50th percentile reported for the procedure in the geozip (percentiles indicate the 

percentage of reported fees that are below the stated amount; for example, 50 percent of reported 

fees fall below the 50th percentile). 

b

Generally, full fees are those charged by health centers for patients with incomes above 200 percent 

of the FPL or those with private coverage. Fees at 100 percent of the FPL are charged by health 

centers for patients with income at or less than 100 percent of the FPL.

c

For patients at or below 100 percent of the FPL, the health center combines multiple services for a 

discounted fee. For example; patients would pay a $40 copayment for a restorative appointment (on 

one or more teeth) which could include a tooth extraction.

d

Health center does not discount this procedure.

e

Health center does not provide/subsidize dental care for patients with income at or above 

200 percent of the FPL.
 

Page 30 GAO-13-754 Dental Services Coverage and Payments

f

To assist health centers in establishing sliding fee schedules for lowincome patients, HRSA officials told us that, as of June 2013, they were 

in the process of preparing guidance on discounting fees for all services 

provided as part of a health center’s scope of project, including dental 

services. In technical comments on a draft of this report, HHS noted that 

the draft guidance was in final clearance, indicating that it was uncertain 

whether the final policy would include guidance on establishing full-fee 

schedules. According to HHS, there is often a significant unmet need for 

dental care services among patients served by health centers and as a 

result, health centers and their community boards must make decisions 

about whether to provide additional dental services to meet this need and 

develop a fee schedule consistent with Health Center Program 

requirements. HHS commented that variation in fees and discounts reflect 

each health center's unique community characteristics as well as the 

board's decision on how best to balance their ability to provide these 

services against the unmet need in their community.

Health center does not operate an in-house dental program, but contracts for dental care with a local 

dentist. Dental patients with income below 200 percent of the FPL are charged a $20 copayment, and 

can receive up to $150 worth of dental services per year.

HHS reviewed a draft of this report and provided technical comments, 

which we incorporated as appropriate.

As agreed with your office, unless you publicly announce the contents of 

this report earlier, we plan no further distribution until 30 days from the 

report date. At that time, we will send copies to the Secretary of Health 

and Human Services, interested congressional committees, and others. 

In addition, the report will be available at no charge on the GAO website 

at http://www.gao.gov. 

Agency Comments
 

Page 31 GAO-13-754 Dental Services Coverage and Payments

If you or your staff have any questions about this report, please contact 

me at (202) 512-7114 or iritanik@gao.gov. Contact points for our Offices 

of Congressional Relations and Public Affairs may be found on the last 

page of this report. GAO staff who made major contributions to this report 

are listed in appendix V.

Sincerely yours, 

Katherine Iritani

Director, Health Care
Appendix I: National Dental Expenditures

Page 32 GAO-13-754 Dental Services Coverage and Payments

To determine national trends in U.S. dental expenditures, we obtained 

national expenditure data from HHS’s Centers for Medicare & Medicaid 

Services’ (CMS) Office of the Actuary. In 2011, national expenditures for 

dental services in the United States were about $108 billion, an inflationadjusted increase from $64 billion in 1996 (see fig. 9). Inflation-adjusted 

expenditures in the United States for dental services rose an average of 

3.6 percent per year between 1996 and 2011—ranging from a 0.8 percent 

decrease in 2009 to a 6.9 percent increase in 2002.

Figure 9: National Expenditures for Dental Services, Adjusted for Inflation, 1996-2011

Notes: Data are from the National Health Expenditure Accounts. The expenditures in this figure have 

been adjusted to 2011 dollars using the 2011 Gross Domestic Product index and conversion factors.

Appendix I: National Dental Expenditures
Appendix II: Urban and Rural Dental Visit 

Rates

Page 33 GAO-13-754 Dental Services Coverage and Payments

Individuals who lived in urban and rural areas reported dental visits at 

different rates, with individuals in urban areas reporting higher rates of 

dental visits. For example, in all age groups, fewer individuals in rural 

areas reported having a dental visit than individuals in urban areas (see 

fig. 10). Specifically, 34 percent of individuals ages 65 and older living in 

rural areas had dental visits in a year, compared with 45 percent of their 

counterparts in urban areas, for 2008 through 2010. The rates for children 

were similar: 35 percent of children 0 to 20 years old living in rural areas 

reported a dental visit in a year, compared with 45 percent of children in 

urban areas.

Figure 10: Percentage of Individuals with a Dental Visit, by Age and Location, 2008-

2010

Notes: Data are from the Medical Expenditure Panel Survey (MEPS). This figure includes the 

noninstitutionalized population with a dental visit during the year and reflects 3 years of MEPS data to 

ensure adequate sample sizes for reporting. The categories are based on the size of the urbanized 

population in counties; the nonmetropolitan counties are separated into those that are adjacent to 

metropolitan areas (suburban) and those that are more remote (rural).

Appendix II: Urban and Rural Dental Visit 

Rates 
Appendix III: Scope and Methodology

Page 34 GAO-13-754 Dental Services Coverage and Payments

To provide information on the trends in dental coverage rates, use of 

dental services, and payments by individuals and other payers for dental 

services, we analyzed nationwide data from the Medical Expenditure 

Panel Survey (MEPS). We examined and analyzed data from 3 years: 

1996, 2004, and 2010. We selected these years for our analysis because 

1996 was the first year MEPS was administered and 2010 was the most 

recent year for which data were available, we included 2004 to provide 

three points in time for our analysis. MEPS is administered by the 

Department of Health and Human Services’ (HHS) Agency for Healthcare 

Research and Quality (AHRQ) and is a nationally representative survey of 

the noninstitutionalized population, including families, medical providers, 

and employers. MEPS collects self-reported information on individuals’ 

demographics, health and insurance status, and use of medical services 

by setting and provider type, as well as expenses and payments related 

to those medical and dental visits, among other things. We analyzed 

responses to MEPS questions about types of dental insurance coverage, 

number of dental visits, types of dental procedures received, and 

payments made related to those visits. A dental visit refers to care by or 

visits to any type of dental care provider, including general dentists, 

dental hygienists, dental technicians, dental surgeons, orthodontists, 

endodontists, and periodontists. For this report, we referred to all visits as 

dental visits.

To determine whether an individual had private dental insurance 

coverage, we examined MEPS data and noted whether the individual 

reported having dental insurance or had private insurance pay on a dental 

claim during the year. Thus, we considered an individual to have private 

dental coverage if he or she (1) reported having dental insurance or 

(2) had that insurer pay on a dental claim.

To identify adult Medicaid coverage by state, we used a list of states 

provided by the Centers for Medicare & Medicaid Services (CMS) for 

2004 and 2010. For states that were identified as having “limited” or 

“emergency only” dental coverage, we did not consider those benefits to 

be Medicaid dental coverage. Our analysis of adult Medicaid coverage 

based on the list from CMS resulted in only small differences from a 

Appendix III: Scope and Methodology
Appendix III: Scope and Methodology

Page 35 GAO-13-754 Dental Services Coverage and Payments

similar analysis conducted by AHRQ for its Chartbook 17 publication that 

examines dental coverage and expenses.1

To categorize dental procedure codes, we consulted with AHRQ and 

used the same categories used by AHRQ for its Chartbook 17. For 

example, AHRQ placed various dental procedure codes related to 

preventive dental care—such as teeth cleaning and sealant application—

in the preventive services category.

In MEPS, expenses are defined as the sum of payments for care 

received, including out-of-pocket payments and payments made by 

private insurance, Medicaid, Medicare, and other sources. For this report, 

we referred to MEPS expenses as payments—payments by insurers or 

other payers as well as out-of-pocket payments made by individuals. To 

present the dental payments in constant 2010 dollars, we used the 

Consumer Price Index for All Urban Consumers (CPI-U) as the price 

deflator for both the aggregate dental payments and the out-of-pocket 

payments.

To identify potential differences in dental service use and payments by 

demographic groups, we looked at responses by age group, income level, 

and urban or rural area. We examined income level in terms of the federal

poverty level. To conduct the urban and rural analysis, we assigned 

individuals to one of three groups based on the county they lived in—

each county was designated urban, suburban, or rural based on the Rural 

Urban Continuum Codes (RUCC).2

In conducting the urban and rural analysis, to ensure adequate sample 

sizes, we combined MEPS data for 2008, 2009, and 2010. This was the 

We categorized those individuals as 

follows: those who lived in counties designated 1, 2, or 3 in the RUCC 

were urban; counties designated 4, 6, or 8, suburban; and in counties 

designated 5, 7, or 9, rural.

 

1

Chartbook 17 examined MEPS data related to dental coverage, use and payments in 

1996 and 2004. To calculate Medicaid coverage for 1996, we used AHRQ’s information 

used in the Chartbook. R.J. Manski and E. Brown, Dental Use, Expenses, Private Dental 

Coverage, and Changes, 1996 and 2004, MEPS Chartbook No.17 (Rockville, Md.: 

Agency for Healthcare Research and Quality, 2007). See 

http://www.meps.ahrq.gov/mepsweb/data_files/publications/cb17/cb17.pdf. 

2

For this analysis, we used the 2003 RUCCs. This was the most recent data available at 

the time of our study.
Appendix III: Scope and Methodology

Page 36 GAO-13-754 Dental Services Coverage and Payments

only analysis where a combination of years was necessary. Despite this 

effort, small sample sizes for some analyses limited the reliability of the 

results, and in those cases, we did not report those analyses.

To determine the reliability of the MEPS data, we reviewed related 

documentation, interviewed agency officials, and identified other studies 

that used MEPS to address similar research questions to compare the 

published data with our findings. We determined that the MEPS data 

were sufficiently reliable for the purposes of our report.

To determine the extent to which dental fees varied between and within 

selected communities, we analyzed dental insurance claims data and 

dental fees charged by selected health centers in nine states 

corresponding to the nine U.S. Census Bureau divisions. Using 2010 

Census data, we selected two communities in each state, one large 

based on population and volume of dental claims and one small based on 

population. Our nine selected community pairs, large and small (with 

selected geozips), were Phoenix (850) and Flagstaff (860), Arizona; Los 

Angeles (900) and Fresno (936), California; Miami (331) and Palm Coast 

(321), Florida; Chicago (606) and Champaign (618), Illinois; Boston (021) 

and Pittsfield (012), Massachusetts; Minneapolis (554) and Mankato 

(560), Minnesota; New York (100) and Elmira (148), New York; Nashville 

(372) and Jackson (382), Tennessee; and Dallas (752) and San Angelo 

(768), Texas.

To identify representative dental fees in each community, we analyzed 

(1) 2012 dental insurance claims data compiled by FAIR Health, Inc., as 

of January 2013,

3 and (2) dental fee schedules from selected health 

centers serving these communities. Based on the FAIR Health claims 

data, we selected 24 of the most of commonly billed dental procedures in 

six categories of the American Dental Association’s (ADA) Current Dental 

Terminology (CDT) codes: five diagnostic, five preventive, five restorative, 

three endodontic, three periodontic, and three oral surgery.4

 

3

The FAIR Health data set contained information on 579 Current Dental Terminology 

(CDT) codes in 491 “geozips”—a geozip is an area that shares the first three digits of a 

postal zip code. See 

We 

consulted with academic dental experts and ADA officials to confirm that 

http://www.fairhealth.org/ for more information about FAIR Health 

and the dental claims data set.

4

Codes on Dental Procedures and Nomenclature are the intellectual property of the ADA 

as copyright owner.
Appendix III: Scope and Methodology

Page 37 GAO-13-754 Dental Services Coverage and Payments

the CDT codes we selected were representative of common dental 

procedures. We also compared our list of common dental procedures to 

data from the ADA Survey of Dental Fees.5

For each selected dental procedure, we extracted from the FAIR Health 

data set the midpoint dental fee (the 50th percentile) and the upper-end 

fee (the 95th percentile). A percentile indicates the percentage of reported 

fees that were below the stated amount; for example, 95 percent of 

reported fees fall below the 95th percentile. Within each community, we 

selected one geozip (an area that shares the first three digits of a postal 

zip code) with the most dental claims to represent the community. 

Because geozip boundaries do not align with metropolitan statistical area 

designations, we selected one geozip (the one with the most dental 

claims) to represent each large and each small metropolitan area. Large 

metropolitan areas can include multiple geozips. For example, the Los 

Angeles/Long Beach metropolitan area includes geozips 900 to 912 

(excluding 909).

We also obtained health 

center dental fees for these 24 procedures in our 18 selected 

communities. Based on a list of health centers provided by HHS’s Health 

Resources and Services Administration (HRSA), we selected one health 

center (the center that served the most dental patients) in each 

community. We obtained full-fee and sliding fee schedules from each 

health center, although some health centers did not provide or bill 

separately for all 24 procedures. The 18 health centers studied may not 

be representative of the more than 1,200 health centers supported by 

HRSA.

To determine the reliability of the FAIR Health and health center data, we 

reviewed related documentation, interviewed agency officials and 

academic experts, and conducted data testing for missing data. We 

determined that both the FAIR Health and health center data were 

sufficiently reliable for the purposes of our report.

 

5

American Dental Association, 2011 Survey of Dental Fees (Chicago, Ill.: December 

2011). 
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 38 GAO-13-754 Dental Services Coverage and Payments

This appendix presents information on local dentist fees and health center 

fees for 24 common dental procedures in the 18 communities (by specific 

geozips) we examined (see tables 10 to 27).

Table 10: Dental Fees Charged for Common Procedures in Phoenix, Arizona (850), 2012

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Diagnostic

d

D0120 Periodic Oral Evaluation – Established Patient $45 $62 $35 $42

D0150 Comprehensive Oral Evaluation – New or Established 

Patient

75 95 35 72

D0220 Radiographs/Diagnostic Imaging: Intraoral – Periapical 

First Film

25 35 24 24

D0230 Radiographs/Diagnostic Imaging: Intraoral – Periapical 

Each Additional Film

20 29 20 20

D0274 Radiographs/Diagnostic Imaging: Bitewings – Four 

Films

53 71 35 52

Preventive

D1110 Prophylaxis – Adult 81 99 35 74

D1120 Prophylaxis – Child 63 77 35 56

D1203 Topical Application of Fluoride – Child 30 40 30 30

D1204 Topical Application of Fluoride – Adult 30 40 32 32

D1351 Sealant – per Tooth 46 56 35 46

Restorative

D2330 Resin-Based Composite – One Surface, Anterior 141 190 35 128

D2391 Resin-Based Composite – One Surface, Posterior 155 219 35 144

D2392 Resin-Based Composite – Two Surfaces, Posterior 195 325 35 188

D2393 Resin-Based Composite – Three Surfaces, Posterior 237 363 35 234

D2950 Core Buildup, Including Any Pins 230 310 35 224

Endodontics

D3310 Endodontic Therapy, Anterior Tooth (Excluding Final 

Restoration)

677 950 200 586

D3320 Endodontic Therapy, Bicuspid Tooth (Excluding Final 

Restoration)

789 1,000 300 686

D3330 Endodontic Therapy, Molar (Excluding Final 

Restoration)

1,045 1,250 400 840

Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities 
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 39 GAO-13-754 Dental Services Coverage and Payments

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Periodontics

d

D4341 Periodontal Scaling and Root Planing – Four or More 

Teeth per Quadrant

232 287 35 204

D4381 Localized Delivery of Antimicrobial Agents via a 

Controlled Release Vehicle Into Diseased Crevicular 

Tissue, per Tooth, by Report

45 104 e

D4910

e

Periodontal Maintenance 122 175 35 116

Oral surgery

D7140 Extraction, Erupted Tooth or Exposed Root (Elevation 

and/or Forceps Removal)

125 195 35 132

D7210 Surgical Removal of Erupted Tooth Requiring Removal 

of Bone and/or Sectioning of Tooth, and Including 

Elevation of the Mucoperlosteal Flap if Indicated

240 300 35 224

D7240 Removal of Impacted Tooth – Completely Bony 400 490 e

Source: GAO analysis of FAIR Health and health center data (as of January 2013).

e

Note: Current Dental Terminology (CDT) Codes on Dental Procedures and Nomenclature are the 

intellectual property of the American Dental Association (ADA) as copyright owner.

a

Midpoint fees are the 50th percentile (percentiles indicate the percentage of reported fees that are 

below the stated amount; for example, 50 percent of reported fees fall below the 50th percentile).

b

Upper-end fees are the 95th percentile.

c

100 percent federal poverty level (FPL) are fees charged by the health center for patients with 

income at or less than 100 percent of the FPL.

d

Full fees are those charged by the health center for patients with income above 200 percent of FPL 

or for those with private coverage.

e

Health center does not provide or bill separately for this procedure.
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 40 GAO-13-754 Dental Services Coverage and Payments

Table 11: Dental Fees Charged for Common Procedures in Flagstaff, Arizona (860), 2012

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100 FPL Full fee c

Diagnostic

d

D0120 Periodic Oral Evaluation – Established Patient $47 $55 $26 $52

D0150 Comprehensive Oral Evaluation – New or Established 

Patient

78 99 44 88

D0220 Radiographs/Diagnostic Imaging: Intraoral – Periapical 

First Film

26 34 17 34

D0230 Radiographs/Diagnostic Imaging: Intraoral – Periapical 

Each Additional Film

22 27 12 24

D0274 Radiographs/Diagnostic Imaging: Bitewings – Four Films 59 70 45 90

Preventive

D1110 Prophylaxis – Adult 85 99 47 94

D1120 Prophylaxis – Child 65 68 34 68

D1203 Topical Application of Fluoride – Child 34 38 20 40

D1204 Topical Application of Fluoride – Adult 28 40 24 48

D1351 Sealant – per Tooth 50 55 28.5 57

Restorative

D2330 Resin-Based Composite – One Surface, Anterior 149 168 84.5 169

D2391 Resin-Based Composite – One Surface, Posterior 160 195 93.5 187

D2392 Resin-Based Composite – Two Surfaces, Posterior 206 266 131.5 263

D2393 Resin-Based Composite – Three Surfaces, Posterior 255 328 163.5 327

D2950 Core Buildup, Including Any Pins 250 309 138.5 277

Endodontics

D3310 Endodontic Therapy, Anterior Tooth (Excluding Final 

Restoration)

700 825 400 800

D3320 Endodontic Therapy, Bicuspid Tooth (Excluding Final 

Restoration)

750 955 437.5 875

D3330 Endodontic Therapy, Molar (Excluding Final 

Restoration)

1,100 1,169 578.5 1,157

Periodontics

D4341 Periodontal Scaling and Root Planing – Four or More 

Teeth per Quadrant

236 305 172.5 345

D4381 Localized Delivery of Antimicrobial Agents via a 

Controlled Release Vehicle Into Diseased Crevicular 

Tissue, per Tooth, by Report

49 60 e

D4910

e

Periodontal Maintenance 130 159 69 138
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 41 GAO-13-754 Dental Services Coverage and Payments

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100 FPL Full fee c

Oral surgery

d

D7140 Extraction, Erupted Tooth or Exposed Root (Elevation 

and/or Forceps Removal)

149 185 89.5 179

D7210 Surgical Removal of Erupted Tooth Requiring 

Removal of Bone and/or Sectioning of Tooth, and 

Including Elevation of the Mucoperlosteal Flap if 

Indicated

250 319 142.5 285

D7240 Removal of Impacted Tooth – Completely Bony 350 395 e

Source: GAO analysis of FAIR Health and health center data (as of January 2013).

e

Note: Current Dental Terminology (CDT) Codes on Dental Procedures and Nomenclature are the 

intellectual property of the American Dental Association (ADA) as copyright owner.

a

Midpoint fees are the 50th percentile (percentiles indicate the percentage of reported fees that are 

below the stated amount; for example, 50 percent of reported fees fall below the 50th percentile).

b

Upper-end fees are the 95th percentile.

c

100 percent federal poverty level (FPL) are fees charged by the health center for patients with 

income at or less than 100 percent of the FPL.

d

Full fees are those charged by the health center for patients with income above 200 percent of the 

FPL or for those with private coverage.

e

Health center does not provide or bill separately for this procedure.
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 42 GAO-13-754 Dental Services Coverage and Payments

Table 12: Dental Fees Charged for Common Procedures in Los Angeles, California (900), 2012

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Diagnostic

d

D0120 Periodic Oral Evaluation – Established Patient $63 $110 $0 $150

D0150 Comprehensive Oral Evaluation – New or Established 

Patient

89 150 0 200

D0220 Radiographs/Diagnostic Imaging: Intraoral – Periapical 

First Film

30 50 e

D0230

e

Radiographs/Diagnostic Imaging: Intraoral – Periapical 

Each Additional Film

20 40 e

D0274

e

Radiographs/Diagnostic Imaging: Bitewings – Four Films 70 100 e

Preventive

e

D1110 Prophylaxis – Adult 100 150 0 120

D1120 Prophylaxis – Child 85 120 0 90

D1203 Topical Application of Fluoride – Child 40 90 0 54

D1204 Topical Application of Fluoride – Adult 40 80 0 18

D1351 Sealant – per Tooth 66 102 0 66

Restorative

D2330 Resin-Based Composite – One Surface, Anterior 163 290 0 165

D2391 Resin-Based Composite – One Surface, Posterior 185 300 0 117

D2392 Resin-Based Composite – Two Surfaces, Posterior 237 365 0 144

D2393 Resin-Based Composite – Three Surfaces, Posterior 280 414 0 171

D2950 Core Buildup, Including Any Pins 250 390 e

Endodontics

e

D3310 Endodontic Therapy, Anterior Tooth (Excluding Final 

Restoration)

690 1,200 e

D3320

e

Endodontic Therapy, Bicuspid Tooth (Excluding Final 

Restoration)

800 1,400 e

D3330

e

Endodontic Therapy, Molar (Excluding Final 

Restoration)

1,000 1,700 0 500

Periodontics

D4341 Periodontal Scaling and Root Planing – Four or More 

Teeth per Quadrant

240 350 0 84

D4381 Localized Delivery of Antimicrobial Agents via a 

Controlled Release Vehicle Into Diseased Crevicular 

Tissue, per Tooth, by Report

80 194 e

D4910

e

Periodontal Maintenance 145 195 0 72
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 43 GAO-13-754 Dental Services Coverage and Payments

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Oral surgery

d

D7140 Extraction, Erupted Tooth or Exposed Root (Elevation 

and/or Forceps Removal)

157 300 0 54

D7210 Surgical Removal of Erupted Tooth Requiring 

Removal of Bone and/or Sectioning of Tooth, and 

Including Elevation of the Mucoperlosteal Flap if 

Indicated

275 495 0 96

D7240 Removal of Impacted Tooth – Completely Bony 450 754 e

Source: GAO analysis of FAIR Health and health center data (as of January 2013).

e

Note: Current Dental Terminology (CDT) Codes on Dental Procedures and Nomenclature are the 

intellectual property of the American Dental Association (ADA) as copyright owner.

a

Midpoint fees are the 50th percentile (percentiles indicate the percentage of reported fees that are 

below the stated amount; for example, 50 percent of reported fees fall below the 50th percentile).

b

Upper-end fees are the 95th percentile.

c

For patients with income at or below 100 percent of the federal poverty level (FPL), fees are 

discounted 100 percent.

d

Full fees are those charged by the health center for patients with income above 200 percent of the 

FPL or for those with private coverage.

e

Health center does not provide or bill separately for this procedure.
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 44 GAO-13-754 Dental Services Coverage and Payments

Table 13: Dental Fees Charged for Common Procedures in Fresno, California (936), 2012

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Diagnostic

d

D0120 Periodic Oral Evaluation – Established Patient $45 $66 $0 $53

D0150 Comprehensive Oral Evaluation – New or Established 

Patient

72 107 0 93

D0220 Radiographs/Diagnostic Imaging: Intraoral – Periapical 

First Film

27 40 0 30

D0230 Radiographs/Diagnostic Imaging: Intraoral – Periapical 

Each Additional Film

17 30 0 26

D0274 Radiographs/Diagnostic Imaging: Bitewings – Four Films 60 83 0 68

Preventive

D1110 Prophylaxis – Adult 88 108 0 95

D1120 Prophylaxis – Child 71 91 0 71

D1203 Topical Application of Fluoride – Child 30 50 0 39

D1204 Topical Application of Fluoride – Adult 31 50 0 39

D1351 Sealant – per Tooth 50 75 0 57

Restorative

D2330 Resin-Based Composite – One Surface, Anterior 148 194 0 171

D2391 Resin-Based Composite – One Surface, Posterior 160 225 0 189

D2392 Resin-Based Composite – Two Surfaces, Posterior 208 288 0 246

D2393 Resin-Based Composite – Three Surfaces, Posterior 248 364 0 303

D2950 Core Buildup, Including Any Pins 225 325 0 289

Endodontics

D3310 Endodontic Therapy, Anterior Tooth (Excluding Final 

Restoration)

650 895 0 785

D3320 Endodontic Therapy, Bicuspid Tooth (Excluding Final 

Restoration)

775 979 0 905

D3330 Endodontic Therapy, Molar (Excluding Final 

Restoration)

1,013 1,218 0 1,095

Periodontics

D4341 Periodontal Scaling and Root Planing – Four or More 

Teeth per Quadrant

225 311 0 269

D4381 Localized Delivery of Antimicrobial Agents via a 

Controlled Release Vehicle Into Diseased Crevicular

Tissue, per Tooth, by Report

91 150 e

D4910

e

Periodontal Maintenance 138 173 0 147
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 45 GAO-13-754 Dental Services Coverage and Payments

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Oral surgery

d

D7140 Extraction, Erupted Tooth or Exposed Root (Elevation 

and/or Forceps Removal)

142 214 0 188

D7210 Surgical Removal of Erupted Tooth Requiring Removal 

of Bone and/or Sectioning of Tooth, and Including 

Elevation of the Mucoperlosteal Flap if Indicated

250 351 0 294

D7240 Removal of Impacted Tooth – Completely Bony 385 499 e

Source: GAO analysis of FAIR Health and health center data (as of January 2013).

e

Note: Current Dental Terminology (CDT) Codes on Dental Procedures and Nomenclature are the 

intellectual property of the American Dental Association (ADA) as copyright owner.

a

Midpoint fees are the 50th percentile (percentiles indicate the percentage of reported fees that are 

below the stated amount; for example, 50 percent of reported fees fall below the 50th percentile).

b

Upper-end fees are the 95th percentile.

c

For patients with income at or below 100 percent of the federal poverty level (FPL), fees are 

discounted 100 percent and patients are charged a $35 copayment (plus 30 percent of outside lab 

fees).

d

Full fees are those charged by the health center for patients with income above 200 percent of the 

FPL or for those with private coverage.

e

Health center does not provide or bill separately for this procedure.
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 46 GAO-13-754 Dental Services Coverage and Payments

Table 14: Dental Fees Charged for Common Procedures in Miami, Florida (331), 2012

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Diagnostic

d

D0120 Periodic Oral Evaluation – Established Patient $62 $150 $20 $49

D0150 Comprehensive Oral Evaluation – New or Established 

Patient

85 150 30 85

D0220 Radiographs/Diagnostic Imaging: Intraoral – Periapical 

First Film

25 50 10 28

D0230 Radiographs/Diagnostic Imaging: Intraoral – Periapical 

Each Additional Film

22 50 10 24

D0274 Radiographs/Diagnostic Imaging: Bitewings – Four Films 66 140 20 62

Preventive

D1110 Prophylaxis – Adult 95 150 35 90

D1120 Prophylaxis – Child 75 120 25 65

D1203 Topical Application of Fluoride – Child 32 60 10 35

D1204 Topical Application of Fluoride – Adult 49 85 10 36

D1351 Sealant – per Tooth 47 80 20 54

Restorative

D2330 Resin-Based Composite – One Surface, Anterior 154 250 55 160

D2391 Resin-Based Composite – One Surface, Posterior 170 270 60 175

D2392 Resin-Based Composite – Two Surfaces, Posterior 200 320 75 225

D2393 Resin-Based Composite – Three Surfaces, Posterior 255 400 90 279

D2950 Core Buildup, Including Any Pins 250 400 100 264

Endodontics

D3310 Endodontic Therapy, Anterior Tooth (Excluding Final 

Restoration)

850 1,400 400 700

D3320 Endodontic Therapy, Bicuspid Tooth (Excluding Final 

Restoration)

935 1,545 500 814

D3330 Endodontic Therapy, Molar (Excluding Final 

Restoration)

1,163 1,760 600 977

Periodontics

D4341 Periodontal Scaling and Root Planing – Four or More 

Teeth per Quadrant

245 384 70 241

D4381 Localized Delivery of Antimicrobial Agents via a 

Controlled Release Vehicle Into Diseased Crevicular 

Tissue, per Tooth, by Report

60 125 e

D4910

e

Periodontal Maintenance 128 195 55 135
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 47 GAO-13-754 Dental Services Coverage and Payments

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Oral surgery

d

D7140 Extraction, Erupted Tooth or Exposed Root (Elevation 

and/or Forceps Removal)

165 325 70 166

D7210 Surgical Removal of Erupted Tooth Requiring Removal 

of Bone and/or Sectioning of Tooth, and Including 

Elevation of the Mucoperlosteal Flap if Indicated

275 500 110 273

D7240 Removal of Impacted Tooth – Completely Bony 460 750 e

Source: GAO analysis of FAIR Health and health center data (as of January 2013).

e

Note: Current Dental Terminology (CDT) Codes on Dental Procedures and Nomenclature are the 

intellectual property of the American Dental Association (ADA) as copyright owner.

a

Midpoint fees are the 50th percentile (percentiles indicate the percentage of reported fees that are 

below the stated amount; for example, 50 percent of reported fees fall below the 50th percentile).

b

Upper-end fees are the 95th percentile.

c

100 percent federal poverty level (FPL) are fees charged by the health center for patients with 

income at or less than 100 percent of the FPL.

d

Full fees are those charged by the health center for patients with income above 200 percent of the 

FPL or for those with private coverage.

e

Health center does not provide or bill separately for this procedure.
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 48 GAO-13-754 Dental Services Coverage and Payments

Table 15: Dental Fees Charged for Common Procedures in Palm Coast, Florida (321), 2012

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Diagnostic

d

D0120 Periodic Oral Evaluation – Established Patient $36 $49 $0 $52

D0150 Comprehensive Oral Evaluation – New or Established 

Patient

65 88 0 84

D0220 Radiographs/Diagnostic Imaging: Intraoral – Periapical 

First Film

20 28 0 26

D0230 Radiographs/Diagnostic Imaging: Intraoral – Periapical 

Each Additional Film

13 24 0 22

D0274 Radiographs/Diagnostic Imaging: Bitewings – Four Films 46 62 0 56

Preventive

D1110 Prophylaxis – Adult 72 87 0 84

D1120 Prophylaxis – Child 57 65 0 60

D1203 Topical Application of Fluoride – Child 34 36 e

D1204

e

Topical Application of Fluoride – Adult 25 37 e

D1351

e

Sealant – per Tooth 45 58 0 42

Restorative

D2330 Resin-Based Composite – One Surface, Anterior 120 175 0 130

D2391 Resin-Based Composite – One Surface, Posterior 140 191 0 152

D2392 Resin-Based Composite – Two Surfaces, Posterior 175 231 0 196

D2393 Resin-Based Composite – Three Surfaces, Posterior 195 291 0 248

D2950 Core Buildup, Including Any Pins 210 283 0 264

Endodontics

D3310 Endodontic Therapy, Anterior Tooth (Excluding Final 

Restoration)

685 845 0 650

D3320 Endodontic Therapy, Bicuspid Tooth (Excluding Final 

Restoration)

795 990 0 768

D3330 Endodontic Therapy, Molar (Excluding Final Restoration) 940 1,200 0 988

Periodontics

D4341 Periodontal Scaling and Root Planing – Four or More 

Teeth per Quadrant

183 250 0 244

D4381 Localized Delivery of Antimicrobial Agents via a 

Controlled Release Vehicle Into Diseased Crevicular 

Tissue, per Tooth, by Report

59 95 e

D4910

e

Periodontal Maintenance 100 133 0 140
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 49 GAO-13-754 Dental Services Coverage and Payments

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Oral surgery

d

D7140 Extraction, Erupted Tooth or Exposed Root (Elevation 

and/or Forceps Removal)

135 200 0 134

D7210 Surgical Removal of Erupted Tooth Requiring Removal 

of Bone and/or Sectioning of Tooth, and Including 

Elevation of the Mucoperlosteal Flap if Indicated

219 299 0 248

D7240 Removal of Impacted Tooth – Completely Bony 436 515 e

Source: GAO analysis of FAIR Health and health center data (as of January 2013).

e

Note: Current Dental Terminology (CDT) Codes on Dental Procedures and Nomenclature are the 

intellectual property of the American Dental Association (ADA) as copyright owner.

a

Midpoint fees are the 50th percentile (percentiles indicate the percentage of reported fees that are 

below the stated amount; for example, 50 percent of reported fees fall below the 50th percentile).

b

Upper-end fees are the 95th percentile.

c

For patients with income at or below 100 percent of the federal poverty level (FPL), fees are 

discounted 100 percent and patients are charged a $45 copayment.

d

Full fees are those charged by the health center for patients with income above 200 percent of the 

FPL or for those with private coverage.

e

Health center does not provide or bill separately for this procedure.
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 50 GAO-13-754 Dental Services Coverage and Payments

Table 16: Dental Fees Charged for Common Procedures in Chicago, Illinois (606), 2012

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Diagnostic

d

D0120 Periodic Oral Evaluation – Established Patient $49 $72 $30 $35

D0150 Comprehensive Oral Evaluation – New or Established 

Patient

75 114 30 50

D0220 Radiographs/Diagnostic Imaging: Intraoral – Periapical 

First Film

25 40 30 19

D0230 Radiographs/Diagnostic Imaging: Intraoral – Periapical 

Each Additional Film

20 35 30 19

D0274 Radiographs/Diagnostic Imaging: Bitewings – Four Films 60 83 30 50

Preventive

D1110 Prophylaxis – Adult 90 120 30 72

D1120 Prophylaxis – Child 65 87 30 53

D1203 Topical Application of Fluoride – Child 35 51 30 28

D1204 Topical Application of Fluoride – Adult 30 50 30 28

D1351 Sealant – per Tooth 52 72 30 39

Restorative

D2330 Resin-Based Composite – One Surface, Anterior 150 225 30 99

D2391 Resin-Based Composite – One Surface, Posterior 160 235 30 110

D2392 Resin-Based Composite – Two Surfaces, Posterior 205 290 30 145

D2393 Resin-Based Composite – Three Surfaces, Posterior 236 350 30 175

D2950 Core Buildup, Including Any Pins 250 367 30 195

Endodontics

D3310 Endodontic Therapy, Anterior Tooth (Excluding Final 

Restoration)

700 1,025 30 495

D3320 Endodontic Therapy, Bicuspid Tooth (Excluding Final 

Restoration)

800 1,200 30 590

D3330 Endodontic Therapy, Molar (Excluding Final Restoration) 1,000 1,500 30 710

Periodontics

D4341 Periodontal Scaling and Root Planing – Four or More 

Teeth per Quadrant

222 300 30 185

D4381 Localized Delivery of Antimicrobial Agents via a 

Controlled Release Vehicle Into Diseased Crevicular 

Tissue, per Tooth, by Report

40 83 e

D4910

e

Periodontal Maintenance 131 176 30 119
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 51 GAO-13-754 Dental Services Coverage and Payments

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Oral surgery

d

D7140 Extraction, Erupted Tooth or Exposed Root (Elevation 

and/or Forceps Removal)

150 240 30 105

D7210 Surgical Removal of Erupted Tooth Requiring Removal of 

Bone and/or Sectioning of Tooth, and Including Elevation 

of the Mucoperlosteal Flap if Indicated

260 390 30 262

D7240 Removal of Impacted Tooth – Completely Bony 500 661 e

Source: GAO analysis of FAIR Health and health center data (as of January 2013).

e

Note: Current Dental Terminology (CDT) Codes on Dental Procedures and Nomenclature are the 

intellectual property of the American Dental Association (ADA) as copyright owner.

a

Midpoint fees are the 50th percentile (percentiles indicate the percentage of reported fees that are 

below the stated amount; for example, 50 percent of reported fees fall below the 50th percentile).

b

Upper-end fees are the 95th percentile.

c

Patients with income at or below 100 percent of the federal poverty level (FPL) are charged $30 per 

visit plus $30 per procedure.

d

Full fees are those charged by the health center for patients with income above 200 percent of the 

FPL or for those with private coverage.

e

Health center does not provide or bill separately for this procedure.
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 52 GAO-13-754 Dental Services Coverage and Payments

Table 17: Dental Fees Charged for Common Procedures in Champaign, Illinois (618), 2012

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Diagnostic

d

D0120 Periodic Oral Evaluation – Established Patient $40 $50 $20 $28

D0150 Comprehensive Oral Evaluation – New or Established 

Patient

77 87 40 55

D0220 Radiographs/Diagnostic Imaging: Intraoral – Periapical 

First Film

26 31 20 c

D0230 Radiographs/Diagnostic Imaging: Intraoral – Periapical 

Each Additional Film

21 26 16 c

D0274 Radiographs/Diagnostic Imaging: Bitewings – Four Films 59 70 43 c

Preventive

D1110 Prophylaxis – Adult 78 91 60 c

D1120 Prophylaxis – Child 61 67 45 c

D1203 Topical Application of Fluoride – Child 31 38 27 c

D1204 Topical Application of Fluoride – Adult 31 39 28 c

D1351 Sealant – per Tooth 51 57 40 c

Restorative

D2330 Resin-Based Composite – One Surface, Anterior 133 163 40 98

D2391 Resin-Based Composite – One Surface, Posterior 152 180 40 109

D2392 Resin-Based Composite – Two Surfaces, Posterior 208 235 40 141

D2393 Resin-Based Composite – Three Surfaces, Posterior 252 290 40 177

D2950 Core Buildup, Including Any Pins 271 281 40 175

Endodontics

D3310 Endodontic Therapy, Anterior Tooth (Excluding Final 

Restoration)

726 795 517 c

D3320 Endodontic Therapy, Bicuspid Tooth (Excluding Final 

Restoration)

836 895 449 c

D3330 Endodontic Therapy, Molar (Excluding Final 

Restoration)

1,005 1,025 549 c

Periodontics

D4341 Periodontal Scaling and Root Planing – Four or More 

Teeth per Quadrant

246 294 196 c

D4381 Localized Delivery of Antimicrobial Agents via a 

Controlled Release Vehicle Into Diseased Crevicular

Tissue, per Tooth, by Report

69 104 e

D4910

e

Periodontal Maintenance 129 143 109 c
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 53 GAO-13-754 Dental Services Coverage and Payments

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Oral surgery

d

D7140 Extraction, Erupted Tooth or Exposed Root (Elevation 

and/or Forceps Removal)

159 190 106 c

D7210 Surgical Removal of Erupted Tooth Requiring Removal 

of Bone and/or Sectioning of Tooth, and Including 

Elevation of the Mucoperlosteal Flap if Indicated

258 301 209 c

D7240 Removal of Impacted Tooth – Completely Bony 471 525 e

Source: GAO analysis of FAIR Health and health center data (as of January 2013).

e

Note: Current Dental Terminology (CDT) Codes on Dental Procedures and Nomenclature are the 

intellectual property of the American Dental Association (ADA) as copyright owner.

a

Midpoint fees are the 50th percentile (percentiles indicate the percentage of reported fees that are 

below the stated amount; for example, 50 percent of reported fees fall below the 50th percentile).

b

Upper-end fees are the 95th percentile.

c

For patients with income at or below 100 percent of the federal poverty level (FPL), fees are per visit: 

$20 for a D0120 with D0220 and possibly D0230; $40 for a D0150 with D0274; $40 for a hygiene 

appointment, which could include D0120, D1110, D1204, D4341, and/or D4910 (if the patient is a 

child not on Medicaid, the visit could also include child codes with one or more sealants (D1351)); 

$40 for a restorative appointment, which could include one or more teeth and all of the codes under 

restorative and D7140 and D7210.

d

Full fees are those charged by the health center for patients with income above 200 percent of the 

FPL or for those with private coverage.

e

Health center does not provide or bill separately for this procedure.
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 54 GAO-13-754 Dental Services Coverage and Payments

Table 18: Dental Fees Charged for Common Procedures in Boston, Massachusetts (021), 2012

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Diagnostic

d

D0120 Periodic Oral Evaluation – Established Patient $49 $65 0 $55

D0150 Comprehensive Oral Evaluation – New or Established 

Patient

86 150 0 88

D0220 Radiographs/Diagnostic Imaging: Intraoral – Periapical 

First Film

30 45 0 33

D0230 Radiographs/Diagnostic Imaging: Intraoral – Periapical 

Each Additional Film

25 40 0 24

D0274 Radiographs/Diagnostic Imaging: Bitewings – Four Films 70 95 0 74

Preventive

D1110 Prophylaxis – Adult 100 131 0 100

D1120 Prophylaxis – Child 78 115 0 63

D1203 Topical Application of Fluoride – Child 38 50 e

D1204

e

Topical Application of Fluoride – Adult 38 53 e

D1351

e

Sealant – per Tooth 65 92 0 51

Restorative

D2330 Resin-Based Composite – One Surface, Anterior 160 225 0 151

D2391 Resin-Based Composite – One Surface, Posterior 179 240 0 163

D2392 Resin-Based Composite – Two Surfaces, Posterior 225 301 0 212

D2393 Resin-Based Composite – Three Surfaces, Posterior 275 370 0 267

D2950 Core Buildup, Including Any Pins 340 460 0 260

Endodontics

D3310 Endodontic Therapy, Anterior Tooth (Excluding Final 

Restoration)

850 1,225 0 675

D3320 Endodontic Therapy, Bicuspid Tooth (Excluding Final 

Restoration)

1,050 1,325 0 785

D3330 Endodontic Therapy, Molar (Excluding Final 

Restoration)

1,350 1,610 0 940

Periodontics

D4341 Periodontal Scaling and Root Planing – Four or More 

Teeth per Quadrant

251 345 0 234

D4381 Localized Delivery of Antimicrobial Agents via a 

Controlled Release Vehicle Into Diseased Crevicular 

Tissue, per Tooth, by Report

63 120 0 168

D4910 Periodontal Maintenance 140 184 0 128
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 55 GAO-13-754 Dental Services Coverage and Payments

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Oral surgery

d

D7140 Extraction, Erupted Tooth or Exposed Root (Elevation 

and/or Forceps Removal)

175 237 0 157

D7210 Surgical Removal of Erupted Tooth Requiring Removal 

of Bone and/or Sectioning of Tooth, and Including 

Elevation of the Mucoperlosteal Flap if Indicated

280 386 0 258

D7240 Removal of Impacted Tooth – Completely Bony 588 795 0 460

Source: GAO analysis of FAIR Health and health center data (as of January 2013).

Note: Current Dental Terminology (CDT) Codes on Dental Procedures and Nomenclature are the 

intellectual property of the American Dental Association (ADA) as copyright owner.

a

Midpoint fees are the 50th percentile (percentiles indicate the percentage of reported fees that are 

below the stated amount; for example, 50 percent of reported fees fall below the 50th percentile).

b

Upper-end fees are the 95th percentile.

c

For patients with income at or below 100 percent of the federal poverty level (FPL), fees are 

discounted 100 percent and patients are charged a $20 copayment.

d

Full fees are those charged by the health center for patients with income above 200 percent of the 

FPL or for those with private coverage.

e

Health center does not provide or bill separately for this procedure.
Appendix IV: Dental Fees Charged for

Common Dental Procedures in 18 

Communities

Page 56 GAO-13-754 Dental Services Coverage and Payments

Table 19: Dental Fees Charged for Common Procedures in Pittsfield, Massachusetts (012), 2012

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Diagnostic

d

D0120 Periodic Oral Evaluation – Established Patient $36 $47 $0 $38

D0150 Comprehensive Oral Evaluation – New or Established 

Patient

68 103 0 51

D0220 Radiographs/Diagnostic Imaging: Intraoral – Periapical 

First Film

25 32 0 24

D0230 Radiographs/Diagnostic Imaging: Intraoral – Periapical 

Each Additional Film

22 30 0 20

D0274 Radiographs/Diagnostic Imaging: Bitewings – Four Films 58 76 0 54

Preventive

D1110 Prophylaxis – Adult 80 95 0 78

D1120 Prophylaxis – Child 56 73 0 56

D1203 Topical Application of Fluoride – Child 27 39 0 31

D1204 Topical Application of Fluoride – Adult 27 30 0 31

D1351 Sealant – per Tooth 49 54 0 46

Restorative

D2330 Resin-Based Composite – One Surface, Anterior 130 163 0 125

D2391 Resin-Based Composite – One Surface, Posterior 135 181 0 145

D2392 Resin-Based Composite – Two Surfaces, Posterior 179 242 0 190

D2393 Resin-Based Composite – Three Surfaces, Posterior 216 249 0 225

D2950 Core Buildup, Including Any Pins 265 309 0 230

Endodontics

D3310 Endodontic Therapy, Anterior Tooth (Excluding Final 

Restoration)

697 995 0 625

D3320 Endodontic Therapy, Bicuspid Tooth (Excluding Final 

Restoration)

875 1,140 0 735

D3330 Endodontic Therapy, Molar (Excluding Final 

Restoration)

1,050 1,495 0 900

Periodontics

D4341 Periodontal Scaling and Root Planing – Four or More 

Teeth per Quadrant

241 290 0 215

D4381 Localized Delivery of Antimicrobial Agents via a 

Controlled Release Vehicle Into Diseased Crevicular 

Tissue, per Tooth, by Report

45 87 e

D4910

e

Periodontal Maintenance 125 144 0 115
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 57 GAO-13-754 Dental Services Coverage and Payments

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Oral surgery

d

D7140 Extraction, Erupted Tooth or Exposed Root (Elevation 

and/or Forceps Removal)

153 185 0 145

D7210 Surgical Removal of Erupted Tooth Requiring 

Removal of Bone and/or Sectioning of Tooth, and 

Including Elevation of the Mucoperlosteal Flap if 

Indicated

255 300 0 235

D7240 Removal of Impacted Tooth – Completely Bony 499 499 0 415

Source: GAO analysis of FAIR Health and health center data (as of January 2013).

Note: Current Dental Terminology (CDT) Codes on Dental Procedures and Nomenclature are the 

intellectual property of the American Dental Association (ADA) as copyright owner.

a

Midpoint fees are the 50th percentile (percentiles indicate the percentage of reported fees that are 

below the stated amount; for example, 50 percent of reported fees fall below the 50th percentile).

b

Upper-end fees are the 95th percentile.

c

Health center offers two levels of discounted fees: 100 percent discount for patients with income 

below 200 percent of the federal poverty level (FPL), and 80 percent discount for patients with income 

at 200 percent to 400 percent of the FPL.

d

Full fees are those charged by the health center for patients with income above 400 percent of the 

FPL or for those with private coverage.

e

Health center does not provide or bill separately for this procedure.
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 58 GAO-13-754 Dental Services Coverage and Payments

Table 20: Dental Fees Charged for Common Procedures in Minneapolis, Minnesota (554), 2012

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Diagnostic

d

D0120 Periodic Oral Evaluation – Established Patient $50 $60 $0 $43

D0150 Comprehensive Oral Evaluation – New or Established 

Patient

77 99 0 75

D0220 Radiographs/Diagnostic Imaging: Intraoral – Periapical 

First Film

29 36 0 25

D0230 Radiographs/Diagnostic Imaging: Intraoral – Periapical 

Each Additional Film

25 34 0 21

D0274 Radiographs/Diagnostic Imaging: Bitewings – Four Films 60 69 0 56

Preventive

D1110 Prophylaxis – Adult 92 111 0 79

D1120 Prophylaxis – Child 65 72 0 59

D1203 Topical Application of Fluoride – Child 42 48 0 32

D1204 Topical Application of Fluoride – Adult 38 48 0 32

D1351 Sealant – per Tooth 53 62 0 47

Restorative

D2330 Resin-Based Composite – One Surface, Anterior 155 186 0 140

D2391 Resin-Based Composite – One Surface, Posterior 170 200 0 153

D2392 Resin-Based Composite – Two Surfaces, Posterior 244 290 0 200

D2393 Resin-Based Composite – Three Surfaces, Posterior 300 363 0 249

D2950 Core Buildup, Including Any Pins 275 340 0 240

Endodontics

D3310 Endodontic Therapy, Anterior Tooth (Excluding Final 

Restoration)

786 911 0 643

D3320 Endodontic Therapy, Bicuspid Tooth (Excluding Final 

Restoration)

917 1,068 0 745

D3330 Endodontic Therapy, Molar (Excluding Final Restoration) 1,122 1,321 0 902

Periodontics

D4341 Periodontal Scaling and Root Planing – Four or More 

Teeth per Quadrant

270 368 0 222

D4381 Localized Delivery of Antimicrobial Agents via a 

Controlled Release Vehicle Into Diseased Crevicular

Tissue, per Tooth, by Report

37 60 0 91

D4910 Periodontal Maintenance 149 182 0 121
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 59 GAO-13-754 Dental Services Coverage and Payments

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Oral surgery

d

D7140 Extraction, Erupted Tooth or Exposed Root (Elevation 

and/or Forceps Removal)

167 200 0 147

D7210 Surgical Removal of Erupted Tooth Requiring Removal 

of Bone and/or Sectioning of Tooth, and Including 

Elevation of the Mucoperlosteal Flap if Indicated

328 385 0 243

D7240 Removal of Impacted Tooth – Completely Bony 545 607 0 428

Source: GAO analysis of FAIR Health and health center data (as of January 2013).

Note: Current Dental Terminology (CDT) Codes on Dental Procedures and Nomenclature are the 

intellectual property of the American Dental Association (ADA) as copyright owner.

a

Midpoint fees are the 50th percentile (percentiles indicate the percentage of reported fees that are 

below the stated amount; for example, 50 percent of reported fees fall below the 50th percentile).

b

Upper-end fees are the 95th percentile.

c

Health center offers three levels of discounted fees: 100 percent discount for patients with income at 

or below 100 percent of the federal poverty level (FPL), 95 percent discount for patients with income

at 101 percent to 150 percent of the FPL, and 80 percent discount for patients with income at 

151 percent to 200 percent of the FPL.

d

Full fees are those charged by the health center for patients with income above 200 percent of the 

FPL or for those with private coverage.
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 60 GAO-13-754 Dental Services Coverage and Payments

Table 21: Dental Fees Charged for Common Procedures in Mankato, Minnesota (560), 2012

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Diagnostic

d

D0120 Periodic Oral Evaluation – Established Patient $41 $48 $0 $35

D0150 Comprehensive Oral Evaluation – New or Established 

Patient

63 81 0 63

D0220 Radiographs/Diagnostic Imaging: Intraoral – Periapical First 

Film

25 33 0 20

D0230 Radiographs/Diagnostic Imaging: Intraoral – Periapical 

Each Additional Film

23 27 0 20

D0274 Radiographs/Diagnostic Imaging: Bitewings – Four Films 52 62 0 48

Preventive

D1110 Prophylaxis – Adult 76 89 0 72

D1120 Prophylaxis – Child 52 62 0 45

D1203 Topical Application of Fluoride – Child 33 40 0 31

D1204 Topical Application of Fluoride – Adult 36 40 0 31

D1351 Sealant – per Tooth 47 50 0 37

Restorative

D2330 Resin-Based Composite – One Surface, Anterior 129 149 0 114

D2391 Resin-Based Composite – One Surface, Posterior 140 173 0 134

D2392 Resin-Based Composite – Two Surfaces, Posterior 194 243 0 166

D2393 Resin-Based Composite – Three Surfaces, Posterior 243 298 0 198

D2950 Core Buildup, Including Any Pins 217 264 0 201

Endodontics

D3310 Endodontic Therapy, Anterior Tooth (Excluding Final 

Restoration)

600 787 0 499

D3320 Endodontic Therapy, Bicuspid Tooth (Excluding Final 

Restoration)

725 987 0 634

D3330 Endodontic Therapy, Molar (Excluding Final Restoration) 899 1,207 0 768

Periodontics

D4341 Periodontal Scaling and Root Planing – Four or More Teeth 

per Quadrant

239 327 0 256

D4381 Localized Delivery of Antimicrobial Agents via a Controlled 

Release Vehicle Into Diseased Crevicular Tissue, per 

Tooth, by Report

39 48 0 64

D4910 Periodontal Maintenance 128 145 0 114
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 61 GAO-13-754 Dental Services Coverage and Payments

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Oral surgery

d

D7140 Extraction, Erupted Tooth or Exposed Root (Elevation 

and/or Forceps Removal)

132 175 0 122

D7210 Surgical Removal of Erupted Tooth Requiring Removal of 

Bone and/or Sectioning of Tooth, and Including Elevation of 

the Mucoperlosteal Flap if Indicated

242 273 0 193

D7240 Removal of Impacted Tooth – Completely Bony 469 486 0 371

Source: GAO analysis of FAIR Health and health center data (as of January 2013).

Note: Current Dental Terminology (CDT) Codes on Dental Procedures and Nomenclature are the 

intellectual property of the American Dental Association (ADA) as copyright owner.

a

Midpoint fees are the 50th percentile (percentiles indicate the percentage of reported fees that are 

below the stated amount; for example, 50 percent of reported fees fall below the 50th percentile).

b

Upper-end fees are the 95th percentile.

c

For patients with income at or below 100 percent of the federal poverty level (FPL), fees are 

discounted 100 percent, but these patients are charged a copayment of $25 for preventive services or 

$40 for restorative or major dental (nonlab services), fees are 50 percent of charges for major dental 

(lab services).

d

Full fees are those charged by the health center for patients with income above 200 percent of the 

FPL or for those with private coverage.
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 62 GAO-13-754 Dental Services Coverage and Payments

Table 22: Dental Fees Charged for Common Procedures in New York, New York (100), 2012

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Diagnostic

d

D0120 Periodic Oral Evaluation – Established Patient $80 $152 $23 $68

D0150 Comprehensive Oral Evaluation – New or Established 

Patient

123 200 46 220

D0220 Radiographs/Diagnostic Imaging: Intraoral – Periapical 

First Film

29 50 11 36

D0230 Radiographs/Diagnostic Imaging: Intraoral – Periapical

Each Additional Film

21 50 6 30

D0274 Radiographs/Diagnostic Imaging: Bitewings – Four Films 80 140 23 80

Preventive

D1110 Prophylaxis – Adult 155 215 46 117

D1120 Prophylaxis – Child 105 160 34 85

D1203 Topical Application of Fluoride – Child 55 100 11 47

D1204 Topical Application of Fluoride – Adult 70 125 11 51

D1351 Sealant – per Tooth 90 125 34 68

Restorative

D2330 Resin-Based Composite – One Surface, Anterior 225 400 46 198

D2391 Resin-Based Composite – One Surface, Posterior 247 375 44 229

D2392 Resin-Based Composite – Two Surfaces, Posterior 300 450 67 292

D2393 Resin-Based Composite – Three Surfaces, Posterior 350 500 85 365

D2950 Core Buildup, Including Any Pins 350 600 75 355

Endodontics

D3310 Endodontic Therapy, Anterior Tooth (Excluding Final 

Restoration)

1,000 1,900 200 891

D3320 Endodontic Therapy, Bicuspid Tooth (Excluding Final 

Restoration)

1,150 1,950 240 1,038

D3330 Endodontic Therapy, Molar (Excluding Final Restoration) 1,400 2,200 325 1,236

Periodontics

D4341 Periodontal Scaling and Root Planing – Four or More 

Teeth per Quadrant

250 420 46 320

D4381 Localized Delivery of Antimicrobial Agents via a Controlled 

Release Vehicle Into Diseased Crevicular Tissue, per 

Tooth, by Report

75 180 130 247

D4910 Periodontal Maintenance 195 295 46 179
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 63 GAO-13-754 Dental Services Coverage and Payments

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Oral surgery

d

D7140 Extraction, Erupted Tooth or Exposed Root (Elevation 

and/or Forceps Removal)

290 600 36 229

D7210 Surgical Removal of Erupted Tooth Requiring Removal of 

Bone and/or Sectioning of Tooth, and Including Elevation 

of the Mucoperlosteal Flap if Indicated

400 750 72 357

D7240 Removal of Impacted Tooth – Completely Bony 650 1,050 240 639

Source: GAO analysis of FAIR Health and health center data (as of January 2013).

Note: Current Dental Terminology (CDT) Codes on Dental Procedures and Nomenclature are the 

intellectual property of the American Dental Association (ADA) as copyright owner.

a

Midpoint fees are the 50th percentile (percentiles indicate the percentage of reported fees that are 

below the stated amount; for example, 50 percent of reported fees fall below the 50th percentile).

b

Upper-end fees are the 95th percentile.

c

100 percent federal poverty level (FPL) are fees charged by the health center for patients with 

income at or below 100 percent of the FPL.

d

Full fees are those charged by the health center for patients with income above 200 percent of the 

FPL or for those with private coverage.
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 64 GAO-13-754 Dental Services Coverage and Payments

Table 23: Dental Fees Charged for Common Procedures in Elmira, New York (148), 2012

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Diagnostic

d

D0120 Periodic Oral Evaluation – Established Patient $40 $52 $0 $28

D0150 Comprehensive Oral Evaluation – New or Established 

Patient

68 106 0 48

D0220 Radiographs/Diagnostic Imaging: Intraoral – Periapical 

First Film

25 33 0 18

D0230 Radiographs/Diagnostic Imaging: Intraoral – Periapical

Each Additional Film

14 26 0 15

D0274 Radiographs/Diagnostic Imaging: Bitewings – Four Films 57 77 0 59

Preventive

D1110 Prophylaxis – Adult 77 95 0 69

D1120 Prophylaxis – Child 54 70 0 52

D1203 Topical Application of Fluoride – Child 30 35 0 21

D1204 Topical Application of Fluoride – Adult 30 40 0 30

D1351 Sealant – per Tooth 50 54 0 35

Restorative

D2330 Resin-Based Composite – One Surface, Anterior 129 161 0 92

D2391 Resin-Based Composite – One Surface, Posterior 145 181 0 132

D2392 Resin-Based Composite – Two Surfaces, Posterior 179 230 0 166

D2393 Resin-Based Composite – Three Surfaces, Posterior 220 315 0 193

D2950 Core Buildup, Including Any Pins 250 350 0 125

Endodontics

D3310 Endodontic Therapy, Anterior Tooth (Excluding Final 

Restoration)

650 950 0 559

D3320 Endodontic Therapy, Bicuspid Tooth (Excluding Final 

Restoration)

751 1,050 0 850

D3330 Endodontic Therapy, Molar (Excluding Final Restoration) 1,000 1,150 0 1,044

Periodontics

D4341 Periodontal Scaling and Root Planing – Four or More 

Teeth per Quadrant

224 260 0 137

D4381 Localized Delivery of Antimicrobial Agents via a 

Controlled Release Vehicle Into Diseased Crevicular 

Tissue, per Tooth, by Report

75 81 e

D4910

e

Periodontal Maintenance 90 138 0 104
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 65 GAO-13-754 Dental Services Coverage and Payments

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Oral surgery

d

D7140 Extraction, Erupted Tooth or Exposed Root (Elevation 

and/or Forceps Removal)

143 180 0 122

D7210 Surgical Removal of Erupted Tooth Requiring Removal 

of Bone and/or Sectioning of Tooth, and Including 

Elevation of the Mucoperlosteal Flap if Indicated

265 325 0 214

D7240 Removal of Impacted Tooth – Completely Bony 460 546 0 365

Source: GAO analysis of FAIR Health and health center data (as of January 2013).

Note: Current Dental Terminology (CDT) Codes on Dental Procedures and Nomenclature are the 

intellectual property of the American Dental Association (ADA) as copyright owner.

a

Midpoint fees are the 50th percentile (percentiles indicate the percentage of reported fees that are 

below the stated amount; for example, 50 percent of reported fees fall below the 50th percentile).

b

Upper-end fees are the 95th percentile.

c

For patients with income at or below 100 percent of the federal poverty level (FPL), health center 

provides a 100 percent discount and charges a $10 copayment (waived at school-based health 

centers).

d

Full fees are those charged by the health center for patients with income above 200 percent of the 

FPL or for those with private coverage.

e

Health center does not provide or bill separately for this procedure.
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 66 GAO-13-754 Dental Services Coverage and Payments

Table 24: Dental Fees Charged for Common Procedures in Nashville, Tennessee (372), 2012

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Diagnostic

d

D0120 Periodic Oral Evaluation – Established Patient $42 $57 $0 $35

D0150 Comprehensive Oral Evaluation – New or Established 

Patient

74 105 0 45

D0220 Radiographs/Diagnostic Imaging: Intraoral – Periapical 

First Film

26 39 0 15

D0230 Radiographs/Diagnostic Imaging: Intraoral – Periapical 

Each Additional Film

22 35 0 12

D0274 Radiographs/Diagnostic Imaging: Bitewings – Four Films 57 75 0 34

Preventive

D1110 Prophylaxis – Adult 76 98 0 45

D1120 Prophylaxis – Child 55 75 0 50

D1203 Topical Application of Fluoride – Child 29 40 0 21

D1204 Topical Application of Fluoride – Adult 26 41 0 20

D1351 Sealant – per Tooth 42 60 0 35

Restorative

D2330 Resin-Based Composite – One Surface, Anterior 140 176 0 75

D2391 Resin-Based Composite – One Surface, Posterior 155 196 0 125

D2392 Resin-Based Composite – Two Surfaces, Posterior 200 287 0 150

D2393 Resin-Based Composite – Three Surfaces, Posterior 245 350 0 160

D2950 Core Buildup, Including Any Pins 242 310 0 250

Endodontics

D3310 Endodontic Therapy, Anterior Tooth (Excluding Final 

Restoration)

794 1,175 0 355

D3320 Endodontic Therapy, Bicuspid Tooth (Excluding Final 

Restoration)

991 1,275 0 425

D3330 Endodontic Therapy, Molar (Excluding Final Restoration) 1,136 1,395 0 519

Periodontics

D4341 Periodontal Scaling and Root Planing – Four or More 

Teeth per Quadrant

215 266 0 600

D4381 Localized Delivery of Antimicrobial Agents via a 

Controlled Release Vehicle Into Diseased Crevicular 

Tissue, per Tooth, by Report

37 43 e

D4910

e

Periodontal Maintenance 122 150 e e
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 67 GAO-13-754 Dental Services Coverage and Payments

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Oral surgery

d

D7140 Extraction, Erupted Tooth or Exposed Root (Elevation 

and/or Forceps Removal)

125 201 0 70

D7210 Surgical Removal of Erupted Tooth Requiring Removal of 

Bone and/or Sectioning of Tooth, and Including Elevation 

of the Mucoperlosteal Flap if Indicated

245 319 0 133

D7240 Removal of Impacted Tooth – Completely Bony 447 475 e

Source: GAO analysis of FAIR Health and health center data (as of January 2013).

e

Note: Current Dental Terminology (CDT) Codes on Dental Procedures and Nomenclature are the 

intellectual property of the American Dental Association (ADA) as copyright owner.

a

Midpoint fees are the 50th percentile (percentiles indicate the percentage of reported fees that are 

below the stated amount; for example, 50 percent of reported fees fall below the 50th percentile).

b

Upper-end fees are the 95th percentile.

c

For patients with income at or below 100 percent of the federal poverty level (FPL), fees are 

discounted 100 percent and patients are charged a $25 copayment.

d

Full fees are those charged by the health center for patients with income above 200 percent of the 

FPL or for those with private coverage.

e

Health center does not provide or bill separately for this procedure.
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 68 GAO-13-754 Dental Services Coverage and Payments

Table 25: Dental Fees Charged for Common Procedures in Jackson, Tennessee (382), 2012

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Diagnostic

d

D0120 Periodic Oral Evaluation – Established Patient $33 $45 c

D0150

d

Comprehensive Oral Evaluation – New or Established 

Patient

53 71 c

D0220

d

Radiographs/Diagnostic Imaging: Intraoral – Periapical First 

Film

20 28 c

D0230

d

Radiographs/Diagnostic Imaging: Intraoral – Periapical Each 

Additional Film

18 25 c

D0274

d

Radiographs/Diagnostic Imaging: Bitewings – Four Films 50 62 c

Preventive

d

D1110 Prophylaxis – Adult 59 71 c

D1120

d

Prophylaxis – Child 48 55 c

D1203

d

Topical Application of Fluoride – Child 24 30 c

D1204

d

Topical Application of Fluoride – Adult 24 30 c

D1351

d

Sealant – per Tooth 43 48 c

Restorative

d

D2330 Resin-Based Composite – One Surface, Anterior 102 137 c

D2391

d

Resin-Based Composite – One Surface, Posterior 125 150 c

D2392

d

Resin-Based Composite – Two Surfaces, Posterior 160 191 c

D2393

d

Resin-Based Composite – Three Surfaces, Posterior 190 245 c

D2950

d

Core Buildup, Including Any Pins 175 213 c

Endodontics

d

D3310 Endodontic Therapy, Anterior Tooth (Excluding Final 

Restoration)

567 700 c

D3320

d

Endodontic Therapy, Bicuspid Tooth (Excluding Final 

Restoration)

635 840 c

D3330

d

Endodontic Therapy, Molar (Excluding Final Restoration) 801 1,044 c

Periodontics

d

D4341 Periodontal Scaling and Root Planing – Four or More Teeth 

per Quadrant

175 211 c

D4381

d

Localized Delivery of Antimicrobial Agents via a Controlled 

Release Vehicle Into Diseased Crevicular Tissue, per Tooth, 

by Report

58 Insufficient 

data

c

D4910

d

Periodontal Maintenance 98 127 c d
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 69 GAO-13-754 Dental Services Coverage and Payments

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Oral surgery

d

D7140 Extraction, Erupted Tooth or Exposed Root (Elevation and/or 

Forceps Removal)

97 138 c

D7210

d

Surgical Removal of Erupted Tooth Requiring Removal of 

Bone and/or Sectioning of Tooth, and Including Elevation of 

the Mucoperlosteal Flap if Indicated

200 250 c

D7240

d

Removal of Impacted Tooth – Completely Bony 365 425 c

Source: GAO analysis of FAIR Health and health center data (as of January 2013).

d

Note: Current Dental Terminology (CDT) Codes on Dental Procedures and Nomenclature are the 

intellectual property of the American Dental Association (ADA) as copyright owner.

a

Midpoint fees are the 50th percentile (percentiles indicate the percentage of reported fees that are 

below the stated amount; for example, 50 percent of reported fees fall below the 50th percentile).

b

Upper-end fees are the 95th percentile.

c

Health center does not operate an in-house dental program, but contracts for dental care with a local 

dentist. Dental patients with income below 200 percent of the federal poverty level (FPL) are charged 

a $20 copayment and can receive up to $150 worth of dental services per year.

d

Health center does not provide or subsidize dental care for patients with income at or above 

200 percent of the FPL.
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 70 GAO-13-754 Dental Services Coverage and Payments

Table 26: Dental Fees Charged for Common Procedures in Dallas, Texas (752), 2012

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Diagnostic

d

D0120 Periodic Oral Evaluation – Established Patient $47 $61 $4.6 $46

D0150 Comprehensive Oral Evaluation – New or Established 

Patient

78 107 8 80

D0220 Radiographs/Diagnostic Imaging: Intraoral – Periapical 

First Film

23 34 2.7 27

D0230 Radiographs/Diagnostic Imaging: Intraoral – Periapical 

Each Additional Film

17 26 2.2 22

D0274 Radiographs/Diagnostic Imaging: Bitewings – Four Films 59 79 6 60

Preventive

D1110 Prophylaxis – Adult 89 110 8.5 85

D1120 Prophylaxis – Child 63 78 6.4 64

D1203 Topical Application of Fluoride – Child 32 38 3.5 35

D1204 Topical Application of Fluoride – Adult 31 39 e

D1351

e

Sealant – per Tooth 50 65 5 50

Restorative

D2330 Resin-Based Composite – One Surface, Anterior 154 220 15 150

D2391 Resin-Based Composite – One Surface, Posterior 146 218 16.7 167

D2392 Resin-Based Composite – Two Surfaces, Posterior 189 294 21.7 217

D2393 Resin-Based Composite – Three Surfaces, Posterior 261 344 26.8 268

D2950 Core Buildup, Including Any Pins 243 313 e

Endodontics

e

D3310 Endodontic Therapy, Anterior Tooth (Excluding Final 

Restoration)

695 1,250 69.4 694

D3320 Endodontic Therapy, Bicuspid Tooth (Excluding Final 

Restoration)

815 1,327 80 800

D3330 Endodontic Therapy, Molar (Excluding Final Restoration) 1,025 1,677 60 600

Periodontics

D4341 Periodontal Scaling and Root Planing – Four or More 

Teeth per Quadrant

245 301 24.1 241

D4381 Localized Delivery of Antimicrobial Agents via a 

Controlled Release Vehicle Into Diseased Crevicular 

Tissue, per Tooth, by Report

60 91 e

D4910

e

Periodontal Maintenance 130 166 e e
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 71 GAO-13-754 Dental Services Coverage and Payments

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Oral surgery

d

D7140 Extraction, Erupted Tooth or Exposed Root (Elevation 

and/or Forceps Removal)

152 245 15.9 159

D7210 Surgical Removal of Erupted Tooth Requiring Removal 

of Bone and/or Sectioning of Tooth, and Including 

Elevation of the Mucoperlosteal Flap if Indicated

265 355 25.7 257

D7240 Removal of Impacted Tooth – Completely Bony 463 564 e

Source: GAO analysis of FAIR Health and health center data (as of January 2013).

e

Note: Current Dental Terminology (CDT) Codes on Dental Procedures and Nomenclature are the 

intellectual property of the American Dental Association (ADA) as copyright owner.

a

Midpoint fees are the 50th percentile (percentiles indicate the percentage of reported fees that are 

below the stated amount; for example, 50 percent of reported fees fall below the 50th percentile).

b

Upper-end fees are the 95th percentile.

c

For patients with income at or below 100 percent of the federal poverty level (FPL), fees are 

discounted 90 percent and patients are charged a $25 copayment.

d

Full fees are those charged by the health center for patients with income above 200 percent of the 

FPL or for those with private coverage.

e

Health center does not provide or bill separately for this procedure.
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 72 GAO-13-754 Dental Services Coverage and Payments

Table 27: Dental Fees Charged for Common Procedures in San Angelo, Texas (768), 2012

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Diagnostic

d

D0120 Periodic Oral Evaluation – Established Patient $38 $60 $15 $74

D0150 Comprehensive Oral Evaluation – New or Established 

Patient

65 91 18 90

D0220 Radiographs/Diagnostic Imaging: Intraoral – Periapical First 

Film

22 30 6 32

D0230 Radiographs/Diagnostic Imaging: Intraoral – Periapical 

Each Additional Film

18 25 6 29

D0274 Radiographs/Diagnostic Imaging: Bitewings – Four Films 51 65 14 68

Preventive

D1110 Prophylaxis – Adult 75 96 21 105

D1120 Prophylaxis – Child 55 72 17 85

D1203 Topical Application of Fluoride – Child 30 40 8 38

D1204 Topical Application of Fluoride – Adult 25 40 8 38

D1351 Sealant – per Tooth 48 60 9 47

Restorative

D2330 Resin-Based Composite – One Surface, Anterior 126 180 28 140

D2391 Resin-Based Composite – One Surface, Posterior 139 193 31 155

D2392 Resin-Based Composite – Two Surfaces, Posterior 180 242 40 200

D2393 Resin-Based Composite – Three Surfaces, Posterior 228 300 48 240

D2950 Core Buildup, Including Any Pins 225 300 23 113

Endodontics

D3310 Endodontic Therapy, Anterior Tooth (Excluding Final 

Restoration)

645 850 490 490 e

D3320 Endodontic Therapy, Bicuspid Tooth (Excluding Final 

Restoration)

715 950 580e 580

D3330 Endodontic Therapy, Molar (Excluding Final Restoration) 948 1,150 f

Periodontics

f

D4341 Periodontal Scaling and Root Planing – Four or More Teeth 

per Quadrant

204 275 100 100 e

D4381 Localized Delivery of Antimicrobial Agents via a Controlled 

Release Vehicle Into Diseased Crevicular Tissue, per 

Tooth, by Report

63 80 f

D4910

f

Periodontal Maintenance 112 158 120 120 e
Appendix IV: Dental Fees Charged for 

Common Dental Procedures in 18 

Communities

Page 73 GAO-13-754 Dental Services Coverage and Payments

Local dentist fee Health center fee

CDT code Description Midpoint Upper-end a b 100% FPL Full fee c

Oral surgery

d

D7140 Extraction, Erupted Tooth or Exposed Root (Elevation 

and/or Forceps Removal)

137 187 148 148 e

D7210 Surgical Removal of Erupted Tooth Requiring Removal of 

Bone and/or Sectioning of Tooth, and Including Elevation of 

the Mucoperlosteal Flap if Indicated

227 322 257 257 e

D7240 Removal of Impacted Tooth – Completely Bony 390 390 f

Source: GAO analysis of FAIR Health and health center data (as of January 2013).

f

Note: Current Dental Terminology (CDT) Codes on Dental Procedures and Nomenclature are the 

intellectual property of the American Dental Association (ADA) as copyright owner.

a

Midpoint fees are the 50th percentile (percentiles indicate the percentage of reported fees that are 

below the stated amount; for example, 50 percent of reported fees fall below the 50th percentile).

b

Upper-end fees are the 95th percentile.

c

100 percent federal poverty level (FPL) are fees charged by the health center for patients with 

income at or below 100 percent of the FPL.

d

Full fees are those charged by the health center for patients with income above 200 percent of the 

FPL or for those with private coverage.

e

Health center does not discount this service.

f

Health center does not provide or bill separately for this procedure.
Appendix V: GAO Contact and Staff 

Acknowledgments

Page 74 GAO-13-754 Dental Services Coverage and Payments

Katherine Iritani, (202) 512-7114, or iritanik@gao.gov

In addition to the individual named above, Kim Yamane, Assistant 

Director; George Bogart; Carolyn Fitzgerald; Mollie Hertel; 

Elizabeth Morrison; and Terry Saiki made key contributions to this 

report.

Appendix V: GAO Contact and Staff 

Acknowledgments 

GAO Contact

Staff 

Acknowledgments 
Related GAO Products

Page 75 GAO-13-754 Dental Services Coverage and Payments

Oral Health: Efforts Under Way to Improve Children’s Access to Dental 

Services, but Sustained Attention Needed to Address Ongoing Concerns. 

GAO-11-96. Washington, D.C.: November 30, 2010.

Medicaid: State and Federal Actions Have Been Taken to Improve 

Children’s Access to Dental Services, but More Can Be Done. 

GAO-10-112T. Washington, D.C.: October 7, 2009.

Medicaid: State and Federal Actions Have Been Taken to Improve 

Children’s Access to Dental Services, but Gaps Remain. GAO-09-723. 

Washington, D.C.: September 30, 2009.

Medicaid: Extent of Dental Disease in Children Has Not Decreased, and 

Millions Are Estimated to Have Untreated Tooth Decay. GAO-08-1121. 

Washington, D.C.: September 23, 2008.

Health Resources and Services Administration: Many Underserved Areas 

Lack a Health Center Site, and the Health Center Program Needs More 

Oversight. GAO-08-723. Washington, D.C.: August 8, 2008.

Medicaid: Concerns Remain about Sufficiency of Data for Oversight of 

Children’s Dental Services. GAO-07-826T. Washington, D.C.: 

May 2, 2007.

Oral Health: Factors Contributing to Low Use of Dental Services by LowIncome Populations. GAO/HEHS-00-149. Washington, D.C.: 

September 11, 2000.

Oral Health: Dental Disease Is a Chronic Problem Among Low-Income 

Populations. GAO/HEHS-00-72. Washington, D.C.: April 12, 2000.

Related GAO Products

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