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Insurance ESTIMATE cALCULATOR
REQUIRED DATA
Office Fee - For planned treatment, our team is always happy to provide our patients with a treatment plan, including our office fee for each planned procedure. We've also listed some of our most commonly used codes/fees below. Please note that some procedures involve multiple procedure codes. For example, a crown sometimes requires an additional procedure called a "build-up", which is a filling that is required to have a crown fit on your tooth.
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D1110 - Prophylaxis (dental cleaning) - $138
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D0120 - Periodic Exam - $70
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D0210 - Full Series X-ray - $185
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D0274 - Four Bitewing X-rays - $86
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D2391 - 1-Surface Filling - $266
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D2740 - Porcelain Crown - $1565
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D2950 - Build-up (often required with a crown) - $325
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D7210 - Surgical Extraction - $390
Insurance Percentage of Coverage - This is the coverage percentages your insurance plan has set for specific types of procedures. Most commonly, we see preventive services covered at 100%, "basic" services like fillings, covered at 80% and "major" services like crowns, covered at 50%. In the calculator below, please enter your percentage as a decimal (100% = 1.00, 80% = .80, 50% = .50)
Maximum Allowable Charge (MAC) or Usual & Customary Rate (UCR) - these are the dollar amounts that insurance companies use to process claims for out of network providers (whereas in network providers have agreed to a set, lower insurance dictated fee). This is done to keep your premiums lower. For example, if a dentist charged $500 for a cleaning, it could not be expected to have an insurance pay 100% of that $500. MAC's/UCR's can vary GREATLY from plan to plan, even within the same insurance company. Most MAC's/UCRs are close to or higher than our office fees, so 100% coverage probably means 100% coverage. But sometimes, they are lower than our office fees (sometimes by quite a lot), which would mean insurance will pay 100% of that lower fee and leave the patient responsible for anything above it. See example below.
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Unfortunately, insurance companies almost never share their MAC/UCRs with providers. So the only way we learn about them is by compiling the data from claims & pre-determinations processed for our patients. So for those group/employer sponsored plans with a large number of patients here locally, we likely have a fair idea of what that plan's coverage looks like. But for all other patients, we recommend calling your insurance company to inquire about their MACs. While they may not provider their actual fee, they will hopefully at least let you know if OUR fee is above or below theirs.
If your estimated out of pocket cost is a negative number, it means that you are estimated to have $0 out of pocket cost. (This happens because the MAC is higher than our Office Fee)