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United States Government Accountability Office: 
GAO: 

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: 

GAO-13-754: 

GAO Highlights: 

Report to the Chairman, Subcommittee on Primary Health and Aging, 
Committee on Health, Education, Labor, and Pensions, U.S. Senate: 

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, over 42 percent of adults with tooth or mouth 
problems did not see a dentist in 2008 because they did not have 
dental insurance and 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 figure). 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). 

Figure: Dental Coverage Status, 1996 and 2010: 

[Refer to PDF for image: 2 pie-charts] 

1996: 
Private: 53%; 
None: 28%; 
Unknown: 10%; 
Medicaid: 9%. 

2010: 
Private: 50%; 
None: 25%; 
Unknown: 12%; 
Medicaid: 13%. 

Source: GAO analysis of HHS data. 

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-of-pocket 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 [hyperlink, http://www.gao.gov/products/GAO-13-754]. For more 
information, contact Katherine Iritani (202) 512-7114 or 
iritanik@gao.gov. 

[End of section] 

Contents: 

Letter: 

Background: 

National Survey Data Show That Rates of Dental Coverage and Use of 
Dental Services Remained Generally Unchanged from 1996 to 2010: 

Average Payments for Dental Services Increased from 1996 to 2010: 

Fees Charged for Dental Services Varied between and within Communities: 

Agency Comments: 

Appendix I: National Dental Expenditures: 

Appendix II: Urban and Rural Dental Visit Rates: 

Appendix III: Scope and Methodology: 

Appendix IV: Dental Fees Charged for Common Dental Procedures in 18 
Communities: 

Appendix V: GAO Contact and Staff Acknowledgments: 

Related GAO Products: 

Tables: 

Table 1: Categories and Examples of Dental Services: 

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

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

Table 4: Percentage of Individuals with a Dental Visit, by Coverage 
Status, 1996, 2004, and 2010: 

Table 5: Average Annual Dental Payments for Individuals with a Dental 
Visit, Adjusted for Inflation, by Coverage Status, 1996, 2004, and 
2010: 

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

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: 

Table 8: Differences between Midpoint and Upper-End Dental Fees 
Charged for a Filling by Local Dentists in 18 Communities in Nine 
States, 2012: 

Table 9: Dental Fees Charged for a Tooth Extraction by Local Dentists 
and Health Centers in 18 Communities in Nine States, 2012: 

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

Table 11: Dental Fees Charged for Common Procedures in Flagstaff, 
Arizona (860), 2012: 

Table 12: Dental Fees Charged for Common Procedures in Los Angeles, 
California (900), 2012: 

Table 13: Dental Fees Charged for Common Procedures in Fresno, 
California (936), 2012: 

Table 14: Dental Fees Charged for Common Procedures in Miami, Florida 
(331), 2012: 

Table 15: Dental Fees Charged for Common Procedures in Palm Coast, 
Florida (321), 2012: 

Table 16: Dental Fees Charged for Common Procedures in Chicago, 
Illinois (606), 2012: 

Table 17: Dental Fees Charged for Common Procedures in Champaign, 
Illinois (618), 2012: 

Table 18: Dental Fees Charged for Common Procedures in Boston, 
Massachusetts (021), 2012: 

Table 19: Dental Fees Charged for Common Procedures in Pittsfield, 
Massachusetts (012), 2012: 

Table 20: Dental Fees Charged for Common Procedures in Minneapolis, 
Minnesota (554), 2012: 

Table 21: Dental Fees Charged for Common Procedures in Mankato, 
Minnesota (560), 2012: 

Table 22: Dental Fees Charged for Common Procedures in New York, New 
York (100), 2012: 

Table 23: Dental Fees Charged for Common Procedures in Elmira, New 
York (148), 2012: 

Table 24: Dental Fees Charged for Common Procedures in Nashville, 
Tennessee (372), 2012: 

Table 25: Dental Fees Charged for Common Procedures in Jackson, 
Tennessee (382), 2012: 

Table 26: Dental Fees Charged for Common Procedures in Dallas, Texas 
(752), 2012: 

Table 27: Dental Fees Charged for Common Procedures in San Angelo, 
Texas (768), 2012: 

Figures: 

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

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

Figure 3: Dental Coverage Rates for Children, Ages 0-20 Years, 1996, 
2004, and 2010: 

Figure 4: Percentage of Children, Ages 0-20 Years, with Private and 
Medicaid Dental Coverage with a Dental Visit, 1996, 2004, and 2010: 

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

Figure 6: Average Annual Payments for Dental Services for Individuals 
with a Dental Visit, Adjusted for Inflation, by Income Level, 1996, 
2004, and 2010: 

Figure 7: Average Annual Out-of-Pocket Payments for Individuals with a 
Dental Visit, 1996, 2004, and 2010: 

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

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

Figure 10: Percentage of Individuals with a Dental Visit, by Age and 
Location, 2008-2010: 

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: 

[End of section] 

GAO:
United States Government Accountability Office: 
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." 
[Footnote 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. 
[Footnote 2] In 2008, over 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. 
[Footnote 3] Similarly, in 2011, 4 million children did not obtain 
needed dental care because their families could not afford it. 
[Footnote 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.[Footnote 5] 

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.[Footnote 6] 
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. 

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). 

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 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.[Footnote 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.[Footnote 8] Therefore, we could 
not determine for this population whether those individuals had dental 
coverage, and we categorized that group as unknown. 

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 dental visits, payments, and coverage status.[Footnote 9] In 
addition, we analyzed variances by demographic group, including age 
group and income level. 

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,[Footnote 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 code [Footnote 11]) 
and American Dental Association (ADA) Current Dental Terminology (CDT) 
billing codes.[Footnote 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.[Footnote 13] 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 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.[Footnote 14] 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 scale dental fee 
schedules from one health center that served each community, although 
some health centers did not provide or bill separately for all 24 
procedures. 

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. 

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 appendix III.) 

Background: 

Dental Services: 

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: Diagnostic; 
Examples: 
* X-ray; 
* Examination. 

Category: Preventive; 
Examples: 
* Cleaning; 
* Fluoride application; 
* Sealant application. 

Category: Restorative; 
Examples: 
* Fillings; 
* Crowns. 

Category: Endodontic; 
Examples: 
* Root canal. 

Category: Periodontic; 
Examples: 
* Treatment of the gums. 

Category: Oral Surgery; 
Examples: 
* Surgical removal of a tooth. 

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

[End of table] 

Dental Coverage: 

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, X-rays, 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.[Footnote 15] After the individual meets the 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). 

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

Program: Medicaid[A] and State Children's Health Insurance Program 
(CHIP); 
Description of dental coverage: 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. 
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] 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. 

Program: Medicare; 
Description of dental coverage: 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.[D] 

Program: Department of Veterans Affairs (VA); 
Description of dental coverage: 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. 

Program: Department of Defense TRICARE; 
Description of dental coverage: 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 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. 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, including dental services. 

[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. 

[End of table] 

Dental Care Provided by Health Centers: 

HHS's HRSA reported that in 2011, over 4 million patients used dental 
services at federally funded health centers.[Footnote 16] 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. 

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.[Footnote 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).[Footnote 18] 

Dental Care under the Patient Protection and Affordable Care Act: 

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.[Footnote 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. 

National Survey Data Show That Rates of Dental Coverage and Use of 
Dental Services Remained Generally Unchanged from 1996 to 2010: 

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. 

Coverage of Dental Services Remained Relatively Unchanged from 1996 to 
2010: 

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.[Footnote 20] 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 of the population, including many individuals covered by 
Medicare and other federal health programs, dental coverage status is 
unknown.[Footnote 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 figure 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. 

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

[Refer to PDF for image: 3 pie-charts] 

1996: 
Private: 53%; 
None: 28%; 
Unknown: 10%; 
Medicaid: 9%. 

2004: 
Private: 54%; 
None: 23%; 
Unknown: 11%; 
Medicaid: 12%. 

2010: 
Private: 50%; 
None: 25%; 
Unknown: 12%; 
Medicaid: 13%. 

Source: GAO analysis of HHS data. 

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 
does 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. 

[End of figure] 

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 figure 2). Individuals in the 
poor-, low-, and middle-income groups saw a decline in the rates of 
private coverage over the same period.[Footnote 22] 

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

[Refer to PDF for image: multiple line graph] 

Year: 1996; 
Poor: 16.7%; 
Low income: 34.8%; 
Middle income: 61.4%; 
High income: 70.3%. 

Year: 2004; 
Poor: 15.2%; 
Low income: 33.1%; 
Middle income: 58.7%; 
High income: 75%. 

Year: 2010; 
Poor: 12.4%; 
Low income: 31.2%; 
Middle income: 55.3%; 
High income: 71.8%. 

Source: GAO analysis of HHS data. 

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 between 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. 

[End of figure] 

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 figure 3). This was the largest increase in coverage for any 
age group in Medicaid. The percentage of children with private dental 
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: 

[Refer to PDF for image: vertical bar graph] 

Dental coverage: Private; 
1996: 53.8%; 
2004: 54.7%; 
2010: 48.2%. 

Dental coverage: Medicaid; 
1996: 17.9%; 
2004: 26%; 
2010: 33%. 

Dental coverage: None; 
1996: 27.1%; 
2004: 18.3%; 
2010: 17.2%. 

Source: GAO analysis of HHS data. 

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. 

[End of figure] 

Use of Dental Services Remained Relatively Unchanged from 1996 to 2010: 

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. 

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

Dental visit; 
1996: 42.9%; 
2004: 43.6%; 
2010: 41.3%. 

No dental visit; 
1996: 57.1%; 
2004: 56.4%; 
2010: 58.7%. 

Total; 
1996: 100.0%; 
2004: 100.0%; 
2010: 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. 

[End of table] 

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: 

Private; 
1996: 56.4%; 
2004: 57.3%; 
2010: 56.9%. 

Medicaid; 
1996: 27.7%; 
2004: 31.6%; 
2010: 33.6%. 

Unknown[A]; 
1996: 33.5%; 
2004: 34.8%; 
2010: 31.8%. 

None; 
1996: 25.8%; 
2004: 21.7%; 
2010: 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 does 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. 

[End of table] 

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 figure 4.) 

Figure 4: Percentage of Children, Ages 0-20 Years, with Private and 
Medicaid Dental Coverage with a Dental Visit, 1996, 2004, and 2010: 

[Refer to PDF for image: vertical bar graph] 

Year: 1996; 
Private: 55.7%; 
Medicaid: 28%. 

Year: 2004; 
Private: 58.1%; 
Medicaid: 33.7%. 

Year: 2010; 
Private: 57.7%; 
Medicaid: 36.8%. 

Source: GAO analysis of HHS data. 

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. 

[End of figure] 

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 of total dental services increased (see 
figure 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: 

[Refer to PDF for image: 3 pie-charts] 

1996: 
Diagnostic: 40%; 
Preventive: 29%; 
Restorative: 8%; 
Other: 25%. 

2004: 
Diagnostic: 43%; 
Preventive: 30%; 
Restorative: 7%; 
Other: 20%. 

2010: 
Diagnostic: 43%; 
Preventive: 33%; 
Restorative: 6%; 
Other: 18%. 

Source: GAO analysis of HHS data. 

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. 

[End of figure] 

Average Payments for Dental Services Increased from 1996 to 2010: 

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.[Footnote 23] 
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. 

Table 5: Average Annual Dental Payments for Individuals with a Dental 
Visit, Adjusted for Inflation, by Coverage Status, 1996, 2004, and 
2010: 

Average payment; 
1996: $520; 
2004: $647; 
2010: $653. 

Private; 
1996: $580; 
2004: $713; 
2010: $719. 

Medicaid; 
1996: $269; 
2004: $356; 
2010: $373. 

Unknown[A]; 
1996: [Empty]; 
2004: $623; 
2010: $630. 

None; 
1996: $406; 
2004: $528; 
2010: $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] 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 does 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. 

[End of table] 

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.[Footnote 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 figure 6), about 42 percent. Average 
annual dental payments also increased for middle-and high-income 
individuals--23 and 25 percent, respectively. 

Figure 6: Average Annual Payments for Dental Services for Individuals 
with a Dental Visit, Adjusted for Inflation, by Income Level, 1996, 
2004, and 2010: 

[Refer to PDF for image: vertical bar graph] 

2010 dollars: 

Family Income: Poor; 
1996: $373; 
2004: $493; 
2010: $437. 

Family Income: Low income; 
1996: $393; 
2004: $500; 
2010: $558. 

Family Income: Middle income; 
1996: $534; 
2004: $588; 
2010: $657. 

Family Income: High income; 
1996: $577; 
2004: $746; 
2010: $721. 

Source: GAO analysis of HHS data. 

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 high-income group is 
individuals in families with income greater than 400 percent of the 
FPL. 

[End of figure] 

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 figure 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 out-of-pocket payments remained relatively unchanged, 
$64 in 1996 and $59 in 2010.[Footnote 25] 

Figure 7: Average Annual Out-of-Pocket Payments for Individuals with a 
Dental Visit, 1996, 2004, and 2010: 

[Refer to PDF for image] 

Insurance: Private; 
1996: $242; 
2004: $286; 
2010: $294. 

Insurance: Medicaid; 
1996: $64; 
2004: $67; 
2010: $59. 

Insurance: None; 
1996: $392; 
2004: $508; 
2010: $518. 

Source: GAO analysis of HHS data. 

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. 

[End of figure] 

Fees Charged for Dental Services Varied between and within Communities: 

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. 

Dental Fees Varied Widely between Communities: 

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.[Footnote 26] 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 figure 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 
appendix IV for more information on the range of dental fees for other 
common dental procedures in selected communities.) 

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

[Refer to PDF for image: illustrated U.S. map] 

Small communities: 

Champaign, Illinois: 
Adult: $78; 
Child: $62. 

Elmira, New York: 
Adult: $77; 
Child: $54. 

Flagstaff, Arizona: 
Adult: $85; 
Child: $65. 

Fresno, California: 
Adult: $88; 
Child: $71. 

Jackson, Tennessee: 
Adult: $59; 
Child: $48. 

Mankato, Minnesota: 
Adult: $76; 
Child: $52. 

Palm Coast, Florida: 
Adult: $72; 
Child: $57. 

Pittsfield, Massachusetts: 
Adult: $80; 
Child: $56. 

San Angelo, Texas: 
Adult: $75; 
Child: $55. 

Large communities: 

Boston, Massachusetts: 
Adult: $100; 
Child: $78. 

Chicago, Illinois: 
Adult: $90; 
Child: $65. 

Dallas, Texas: 
Adult: $89; 
Child: $63. 

Los Angeles, California: 
Adult: $100; 
Child: $85. 

Miami, Florida: 
Adult: $95; 
Child: $75. 

Minneapolis, Minnesota: 
Adult: $92; 
Child: $65. 

Nashville, Tennessee: 
Adult: $76; 
Child: $55. 

New York, New York: 
Adult: $155; 
Child: $105. 

Phoenix, Arizona: 
Adult: $81; 
Child: $63. 

Source: GAO analysis of FAIR Health data; Map Resources (map). 

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. 

[End of figure] 

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 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.[Footnote 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 Fees Varied Widely within Communities: 

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 appendix IV for information on all 24 procedures in all 18 
selected communities.) 

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

Current Dental Terminology (CDT) code: D4381; 
Description: Localized Delivery of Antimicrobial Agents via a 
Controlled Release Vehicle Into Diseased Crevicular Tissue, per Tooth, 
by Report; 
Community (geozip): Los Angeles, Calif. (900); 
Midpoint fee: $80; 
Upper-end fee: $194; 
Percentage difference: 143%. 

Current Dental Terminology (CDT) code: D0120; 
Description: Periodic Oral Evaluation-Established Patient; 
Community (geozip): Miami, Fla. (331); 
Midpoint fee: $62; 
Upper-end fee: $150; 
Percentage difference: 142%. 

Current Dental Terminology (CDT) code: D0230; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical Each 
Additional Film; 
Community (geozip): New York, N.Y. (100); 
Midpoint fee: $21; 
Upper-end fee: $50; 
Percentage difference: 138%. 

Current Dental Terminology (CDT) code: D1203; 
Description: Topical Application of Fluoride-Child; 
Community (geozip): Los Angeles, Calif. (900); 
Upper-end fee: $40; 
Upper-end fee: $90; 
Percentage difference: 125%. 

Current Dental Terminology (CDT) code: D0274; 
Description: Radiographs/Diagnostic Imaging: Bitewings-Four Films; 
Community (geozip): Miami, Fla. (331); 
Midpoint fee: $66; 
Upper-end fee: $140; 
Percentage difference: 112%. 

Current Dental Terminology (CDT) code: D7140; 
Description: Extraction, Erupted Tooth or Exposed Root (Elevation 
and/or Forceps Removal); 
Community (geozip): New York, N.Y. (100); 
Midpoint fee: $290; 
Upper-end fee: $600; 
Percentage difference: 107%. 

Current Dental Terminology (CDT) code: D0220; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical 
First Film; 
Community (geozip): Miami, Fla. (331); 
Midpoint fee: $25; 
Upper-end fee: $50; 
Percentage difference: 100%. 

Current Dental Terminology (CDT) code: D1204; 
Description: Topical Application of Fluoride-Adult; 
Community (geozip): Los Angeles, Calif. (900); 
Midpoint fee: $40; 
Upper-end fee: $80; 
Percentage difference: 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 percentile). 

[End of table] 

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. 

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: 

Large communities: 
Community (geozip): Miami, Fla. (331); 
Midpoint fee: $62; 
Upper-end fee: $150; 
Percentage difference: 142%. 

Community (geozip): New York, N.Y. (100); 
Midpoint fee: $80; 
Upper-end fee: $152; 
Percentage difference: 90%. 

Community (geozip): Los Angeles, Calif. (900); 
Midpoint fee: $63; 
Upper-end fee: $110; 
Percentage difference: 75%. 

Community (geozip): Chicago, Ill. (606); 
Midpoint fee: $49; 
Upper-end fee: $72; 
Percentage difference: 47%. 

Community (geozip): Phoenix, Ariz. (850); 
Midpoint fee: $45; 
Upper-end fee: $62; 
Percentage difference: 38%. 

Community (geozip): Nashville, Tenn. (372); 
Midpoint fee: $42; 
Upper-end fee: $57; 
Percentage difference: 36%. 

Community (geozip): Boston, Mass. (021); 
Midpoint fee: $49; 
Upper-end fee: $65; 
Percentage difference: 33%. 

Community (geozip): Dallas, Tex. (752); 
Midpoint fee: $47; 
Upper-end fee: $61; 
Percentage difference: 30%. 

Community (geozip): Minneapolis, Minn. (554); 
Midpoint fee: $50; 
Upper-end fee: $60; 
Percentage difference: 20%. 

Small communities: 

Community (geozip): San Angelo, Tex. (768); 
Midpoint fee: $38; 
Upper-end fee: $60; 
Percentage difference: 58%. 

Community (geozip): Fresno, Calif. (936); 
Midpoint fee: $45; 
Upper-end fee: $66; 
Percentage difference: 47%. 

Community (geozip): Jackson, Tenn. (382); 
Midpoint fee: $33; 
Upper-end fee: $45; 
Percentage difference: 36%. 

Community (geozip): Palm Coast, Fla. (321); 
Midpoint fee: $36; 
Upper-end fee: $49; 
Percentage difference: 36%. 

Community (geozip): Pittsfield, Mass. (012); 
Midpoint fee: $36; 
Upper-end fee: $47; 
Percentage difference: 31%. 

Community (geozip): Elmira, N.Y. (148); 
Midpoint fee: $40; 
Upper-end fee: $52; 
Percentage difference: 30%. 

Community (geozip): Champaign, Ill. (618); 
Midpoint fee: $40; 
Upper-end fee: $50; 
Percentage difference: 25%. 

Community (geozip): Mankato, Minn. (560); 
Midpoint fee: $41; 
Upper-end fee: $48; 
Percentage difference: 17%. 

Community (geozip): Flagstaff, Ariz. (860); 
Midpoint fee: $47; 
Upper-end fee: $55; 
Percentage difference: 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 percentile). 

[End of table] 

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 
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: 

Large communities: 

Community (geozip): Phoenix, Ariz. (850); 
Midpoint fee: $195; 
Upper-end fee: $325; 
Percentage difference: 67%. 

Community (geozip): Miami, Fla. (331); 
Midpoint fee: $200; 
Upper-end fee: $320; 
Percentage difference: 60%. 

Community (geozip): Dallas, Tex. (752); 
Midpoint fee: $189; 
Upper-end fee: $294; 
Percentage difference: 56%. 

Community (geozip): Los Angeles, Calif. (900); 
Midpoint fee: $237; 
Upper-end fee: $365; 
Percentage difference: 54%. 

Community (geozip): New York, N.Y. (100); 
Midpoint fee: $300; 
Upper-end fee: $450; 
Percentage difference: 50%. 

Community (geozip): Nashville, Tenn. (372); 
Midpoint fee: $200; 
Upper-end fee: $287; 
Percentage difference: 44%. 

Community (geozip): Chicago, Ill. (606); 
Midpoint fee: $205; 
Upper-end fee: $290; 
Percentage difference: 41%. 

Community (geozip): Boston, Mass. (021); 
Midpoint fee: $225; 
Upper-end fee: $301; 
Percentage difference: 34%. 

Community (geozip): Minneapolis, Minn. (554); 
Midpoint fee: $244; 
Upper-end fee: $290; 
Percentage difference: 19%. 

Small communities: 

Community (geozip): Fresno, Calif. (936); 
Midpoint fee: $208; 
Upper-end fee: $288; 
Percentage difference: 38%. 

Community (geozip): Pittsfield, Mass. (012); 
Midpoint fee: $179; 
Upper-end fee: $242; 
Percentage difference: 35%. 

Community (geozip): San Angelo, Tex. (768); 
Midpoint fee: $180; 
Upper-end fee: $242; 
Percentage difference: 34%. 

Community (geozip): Palm Coast, Fla. (321); 
Midpoint fee: $175; 
Upper-end fee: $231; 
Percentage difference: 32%. 

Community (geozip): Flagstaff, Ariz. (860); 
Midpoint fee: $206; 
Upper-end fee: $266; 
Percentage difference: 29%. 

Community (geozip): Elmira, N.Y. (148); 
Midpoint fee: $179; 
Upper-end fee: $230; 
Percentage difference: 28%. 

Community (geozip): Mankato, Minn. (560); 
Midpoint fee: $194; 
Upper-end fee: $243; 
Percentage difference: 25%. 

Community (geozip): Jackson, Tenn. (382); 
Midpoint fee: $160; 
Upper-end fee: $191; 
Percentage difference: 19%. 

Community (geozip): Champaign, Ill. (618); 
Midpoint fee: $208; 
Upper-end fee: $235; 
Percentage difference: 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). 

[End of table] 

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.[Footnote 
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 appendix IV for 
additional information on local dentist fees and health center dental 
fees.) 

Table 9: Dental Fees Charged for a Tooth Extraction by Local Dentists 
and Health Centers in 18 Communities in Nine States, 2012: 

Large communities: 

Community (geozip): New York, N.Y. (100); 
Local dentists' midpoint fee[A]: $290; 
Health centers'[B]: Full fee: $229; 
100% of federal poverty level (FPL): $36. 

Community (geozip): Boston, Mass. (021); 
Local dentists' midpoint fee[A]: $175; 
Health centers'[B]: Full fee: $157; 
100% of federal poverty level (FPL): 0. 

Community (geozip): Minneapolis, Minn. (554); 
Local dentists' midpoint fee[A]: $167; 
Health centers'[B]: Full fee: $147; 
100% of federal poverty level (FPL): 0. 

Community (geozip): Miami, Fla. (331); 
Local dentists' midpoint fee[A]: $165; 
Health centers'[B]: Full fee: $166; 
100% of federal poverty level (FPL): $70. 

Community (geozip): Los Angeles, Calif. (900); 
Local dentists' midpoint fee[A]: $157; 
Health centers'[B]: Full fee: $54; 
100% of federal poverty level (FPL): 0. 

Community (geozip): Dallas, Tex. (752); 
Local dentists' midpoint fee[A]: $152; 
Health centers'[B]: Full fee: $159; 
100% of federal poverty level (FPL): $16. 

Community (geozip): Chicago, Ill. (606); 
Local dentists' midpoint fee[A]: $150; 
Health centers'[B]: Full fee: $105; 
100% of federal poverty level (FPL): 0. 

Community (geozip): Phoenix, Ariz. (850); 
Local dentists' midpoint fee[A]: $125; 
Health centers'[B]: Full fee: $132; 
100% of federal poverty level (FPL): $35. 

Community (geozip): Nashville, Tenn. (372); 
Local dentists' midpoint fee[A]: $125; 
Health centers'[B]: Full fee: $70; 
100% of federal poverty level (FPL): 0. 

Small communities: 

Community (geozip): Champaign, Ill. (618); 
Local dentists' midpoint fee[A]: $159; 
Health centers'[B]: Full fee: $106; 
100% of federal poverty level (FPL): [C]. 

Community (geozip): Pittsfield, Mass. (012); 
Local dentists' midpoint fee[A]: $153; 
Health centers'[B]: Full fee: $145; 
100% of federal poverty level (FPL): 0. 

Community (geozip): Flagstaff, Ariz. (860); 
Local dentists' midpoint fee[A]: $149; 
Health centers'[B]: Full fee: $179; 
100% of federal poverty level (FPL): 90. 

Community (geozip): Elmira, N.Y. (148); 
Local dentists' midpoint fee[A]: $143; 
Health centers'[B]: Full fee: $122; 
100% of federal poverty level (FPL): 0. 

Community (geozip): Fresno, Calif. (936); 
Local dentists' midpoint fee[A]: $142; 
Health centers'[B]: Full fee: $177; 
100% of federal poverty level (FPL): 0. 

Community (geozip): San Angelo, Tex. (768); 
Local dentists' midpoint fee[A]: $137; 
Health centers'[B]: Full fee: $148; 
100% of federal poverty level (FPL): 148[D]. 

Community (geozip): Palm Coast, Fla. (321); 
Local dentists' midpoint fee[A]: $135; 
Health centers'[B]: Full fee: $134; 
100% of federal poverty level (FPL): 0. 

Community (geozip): Mankato, Minn. (560); 
Local dentists' midpoint fee[A]: $132; 
Health centers'[B]: Full fee: $122; 
100% of federal poverty level (FPL): 0. 

Community (geozip): Jackson, Tenn. (382); 
Local dentists' midpoint fee[A]: $97; 
Health centers'[B]: Full fee: [E]; 
100% of federal poverty level (FPL): [F]. 

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

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 at or 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. 

[F] 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. 

[End of table] 

To assist health centers in establishing sliding fee schedules for low-
income 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. 

Agency Comments: 

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 [hyperlink, http://www.gao.gov]. 

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, 

Signed by: 

Katherine Iritani: 
Director, Health Care: 

[End of section] 

Appendix I: National Dental Expenditures: 

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 
inflation-adjusted increase from $64 billion in 1996 (see figure 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: 

[Refer to PDF for image: line graph] 

Year: 1996; 
Expenditures: $64.2 billion. 

Year: 1997; 
Expenditures: $67.6 billion. 

Year: 1998; 
Expenditures: $71.2 billion. 

Year: 1999; 
Expenditures: $75.0 billion. 

Year: 2000; 
Expenditures: $79.6 billion. 

Year: 2001; 
Expenditures: $84.7 billion. 

Year: 2002; 
Expenditures: $90.6 billion. 

Year: 2003; 
Expenditures: $91.9 billion. 

Year: 2004; 
Expenditures: $96.1 billion. 

Year: 2005; 
Expenditures: $98.6 billion. 

Year: 2006; 
Expenditures: $100.4 billion. 

Year: 2007; 
Expenditures: $103.9 billion. 

Year: 2008; 
Expenditures: $106.9 billion. 

Year: 2009; 
Expenditures: $106.1 billion. 

Year: 2010; 
Expenditures: $105.3 billion. 

Year: 2011; 
Expenditures: $108.4 billion. 

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. 

[End of figure] 

[End of section] 

Appendix II: Urban and Rural Dental Visit Rates: 

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 figure 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: 

[Refer to PDF for image: vertical bar graph] 

Age: Under 21; 
Urban: 44.7%; 
Suburban: 41.5%; 
Rural: 35.1%. 

Age: 21-44; 
Urban: 36%; 
Suburban: 33.3%; 
Rural: 31.3%. 

Age: 45-64; 
Urban: 47.8%; 
Suburban: 42%; 
Rural: 33.4%. 

Age: 65 and over; 
Urban: 44.8%; 
Suburban: 41.6%; 
Rural: 34.1%. 

Source: GAO analysis of HHS data. 

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). 

[End of figure] 

[End of section] 

Appendix III: Scope and Methodology: 

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 similar analysis conducted by AHRQ for its Chartbook 17 
publication that examines dental coverage and expenses.[Footnote 29] 

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).[Footnote 30] 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. 

In conducting the urban and rural analysis, to ensure adequate sample 
sizes we combined MEPS data for 2008, 2009, and 2010. This was the 
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,[Footnote 31] 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.[Footnote 32] We consulted with 
academic dental experts and ADA officials to confirm that 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.[Footnote 33] 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 scale dental 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. 

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 same first 3 digits) 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). 

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. 

[End of section] 

Appendix IV: Dental Fees Charged for Common Dental Procedures in 18 
Communities: 

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: 

Diagnostic: 

CDT code: D0120; 
Description: Periodic Oral Evaluation-Established Patient; 
Local dentist fee: 
Midpoint[A]: $45; 
Upper-end[B]: $62; 
Health center fee: 
100% FPL[C]: $35; 
Full fee[D]: $42. 

CDT code: D0150; 
Description: Comprehensive Oral Evaluation-New or Established Patient; 
Local dentist fee: 
Midpoint[A]: $75; 
Upper-end[B]: $95; 
Health center fee: 
100% FPL[C]: $35; 
Full fee[D]: $72. 

CDT code: D0220; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical 
First Film; 
Local dentist fee: 
Midpoint[A]: $25; 
Upper-end[B]: $35; 
Health center fee: 
100% FPL[C]: $24; 
Full fee[D]: $24. 

CDT code: D0230; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical Each 
Additional Film; 
Local dentist fee: 
Midpoint[A]: $20; 
Upper-end[B]: $29; 
Health center fee: 
100% FPL[C]: $20; 
Full fee[D]: $20. 

CDT code: D0274; 
Description: Radiographs/Diagnostic Imaging: Bitewings-Four Films; 
Local dentist fee: 
Midpoint[A]: $53; 
Upper-end[B]: $71; 
Health center fee: 
100% FPL[C]: $35; 
Full fee[D]: $52. 

Preventive: 

CDT code: D1110; 
Description: Prophylaxis-Adult; 
Local dentist fee: 
Midpoint[A]: $81; 
Upper-end[B]: $99; 
Health center fee: 
100% FPL[C]: $35; 
Full fee[D]: $74. 

CDT code: D1120; 
Description: Prophylaxis-Child; 
Local dentist fee: 
Midpoint[A]: $63; 
Upper-end[B]: $77; 
Health center fee: 
100% FPL[C]: $35; 
Full fee[D]: $56. 

CDT code: D1203; 
Description: Topical Application of Fluoride-Child; 
Local dentist fee: 
Midpoint[A]: $30; 
Upper-end[B]: $40; 
Health center fee: 
100% FPL[C]: $30; 
Full fee[D]: $30. 

CDT code: D1204; 
Description: Topical Application of Fluoride-Adult; 
Local dentist fee: 
Midpoint[A]: $30; 
Upper-end[B]: $40; 
Health center fee: 
100% FPL[C]: $32; 
Full fee[D]: $32. 

CDT code: D1351; 
Description: Sealant-per Tooth; 
Local dentist fee: 
Midpoint[A]: $46; 
Upper-end[B]: $56; 
Health center fee: 
100% FPL[C]: $35; 
Full fee[D]: $46. 

Restorative: 

CDT code: D2330; 
Description: Resin-Based Composite-One Surface, Anterior; 
Local dentist fee: 
Midpoint[A]: $141; 
Upper-end[B]: $190; 
Health center fee: 
100% FPL[C]: $35; 
Full fee[D]: $128. 

CDT code: D2391; 
Description: Resin-Based Composite-One Surface, Posterior; 
Local dentist fee: 
Midpoint[A]: $155; 
Upper-end[B]: $219; 
Health center fee: 
100% FPL[C]: $35; 
Full fee[D]: $144. 

CDT code: D2392; 
Description: Resin-Based Composite-Two Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $195; 
Upper-end[B]: $325; 
Health center fee: 
100% FPL[C]: $35; 
Full fee[D]: $188. 

CDT code: D2393; 
Description: Resin-Based Composite-Three Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $237; 
Upper-end[B]: $363; 
Health center fee: 
100% FPL[C]: $35; 
Full fee[D]: $234. 

CDT code: D2950; 
Description: Core Buildup, Including Any Pins; 
Local dentist fee: 
Midpoint[A]: $230; 
Upper-end[B]: $310; 
Health center fee: 
100% FPL[C]: $35; 
Full fee[D]: $224. 

Endodontics: 

CDT code: D3310; 
Description: Endodontic Therapy, Anterior Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $677; 
Upper-end[B]: $950; 
Health center fee: 
100% FPL[C]: $200; 
Full fee[D]: $586. 

CDT code: D3320; 
Description: Endodontic Therapy, Bicuspid Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $789; 
Upper-end[B]: $1,000; 
Health center fee: 
100% FPL[C]: $300; 
Full fee[D]: $686. 

CDT code: D3330; 
Description: Endodontic Therapy, Molar (Excluding Final Restoration); 
Local dentist fee: 
Midpoint[A]: $1,045; 
Upper-end[B]: 1,250; 
Health center fee: 
100% FPL[C]: $400; 
Full fee[D]: $840. 

Periodontics: 

CDT code: D4341; 
Description: Periodontal Scaling and Root Planing-Four or More Teeth 
per Quadrant; 
Local dentist fee: 
Midpoint[A]: $232; 
Upper-end[B]: $287; 
Health center fee: 
100% FPL[C]: $35; 
Full fee[D]: $204. 

CDT code: D4381; 
Description: Localized Delivery of Antimicrobial Agents via a 
Controlled Release Vehicle Into Diseased Crevicular Tissue, per Tooth, 
by Report; 
Local dentist fee: 
Midpoint[A]: $45; 
Upper-end[B]: $104; 
Health center fee: 
100% FPL[C]: [E]; 
Full fee[D]: [E]. 

CDT code: D4910; 
Description: Periodontal Maintenance; 
Local dentist fee: 
Midpoint[A]: $122; 
Upper-end[B]: $175; 
Health center fee: 
100% FPL[C]: $35; 
Full fee[D]: $116. 

Oral surgery: 

CDT code: D7140; 
Description: Extraction, Erupted Tooth or Exposed Root (Elevation 
and/or Forceps Removal); 
Local dentist fee: 
Midpoint[A]: $125; 
Upper-end[B]: $195; 
Health center fee: 
100% FPL[C]: $35; 
Full fee[D]: $132. 

CDT code: D7210; 
Description: Surgical Removal of Erupted Tooth Requiring Removal of 
Bone and/or Sectioning of Tooth, and Including Elevation of the 
Mucoperlosteal Flap if Indicated; 
Local dentist fee: 
Midpoint[A]: $240; 
Upper-end[B]: $300; 
Health center fee: 
100% FPL[C]: $35; 
Full fee[D]: $224. 

CDT code: D7240; 
Description: Removal of Impacted Tooth-Completely Bony; 
Local dentist fee: 
Midpoint[A]: $400; 
Upper-end[B]: $490; 
Health center fee: 
100% FPL[C]: [E]; 
Full fee[D]: [E]. 

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 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. 

[End of table] 

Table 11: Dental Fees Charged for Common Procedures in Flagstaff, 
Arizona (860), 2012: 

Diagnostic: 

CDT code: D0120; 
Description: Periodic Oral Evaluation-Established Patient; 
Local dentist fee: 
Midpoint[A]: $47; 
Upper-end[B]: $55; 
Health center fee: 
100 FPL[C]: $26; 
Full fee[D]: $52. 

CDT code: D0150; 
Description: Comprehensive Oral Evaluation-New or Established Patient; 
Local dentist fee: 
Midpoint[A]: $78; 
Upper-end[B]: $99; 
Health center fee: 
100 FPL[C]: $44; 
Full fee[D]: $88. 

CDT code: D0220; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical 
First Film; 
Local dentist fee: 
Midpoint[A]: $26; 
Upper-end[B]: $34; 
Health center fee: 
100 FPL[C]: $17; 
Full fee[D]: $34. 

CDT code: D0230; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical Each 
Additional Film; 
Local dentist fee: 
Midpoint[A]: $22; 
Upper-end[B]: $27; 
Health center fee: 
100 FPL[C]: $12; 
Full fee[D]: $24. 

CDT code: D0274; 
Description: Radiographs/Diagnostic Imaging: Bitewings-Four Films; 
Midpoint[A]: $59; 
Upper-end[B]: $70; 
Health center fee: 
100 FPL[C]: $45; 
Full fee[D]: $90. 

Preventive: 

CDT code: D1110; 
Description: Prophylaxis-Adult; 
Local dentist fee: 
Midpoint[A]: $85; 
Upper-end[B]: $99; 
Health center fee: 
100 FPL[C]: $47; 
Full fee[D]: $94. 

CDT code: D1120; 
Description: Prophylaxis-Child; 
Local dentist fee: 
Midpoint[A]: $65; 
Upper-end[B]: $68; 
Health center fee: 
100 FPL[C]: $34; 
Full fee[D]: $68. 

CDT code: D1203; 
Description: Topical Application of Fluoride-Child; 
Local dentist fee: 
Midpoint[A]: $34; 
Upper-end[B]: $38; 
Health center fee: 
100 FPL[C]: $20; 
Full fee[D]: $40. 

CDT code: D1204; 
Description: Topical Application of Fluoride-Adult; 
Local dentist fee: 
Midpoint[A]: $28; 
Upper-end[B]: $40; 
Health center fee: 
100 FPL[C]: $24; 
Full fee[D]: $48. 

CDT code: D1351; 
Description: Sealant-per Tooth; 
Local dentist fee: 
Midpoint[A]: $50; 
Upper-end[B]: $55; 
Health center fee: 
100 FPL[C]: $28.5; 
Full fee[D]: $57. 

Restorative: 

CDT code: D2330; 
Description: Resin-Based Composite-One Surface, Anterior; 
Local dentist fee: 
Midpoint[A]: $149; 
Upper-end[B]: $168; 
Health center fee: 
100 FPL[C]: $84.5; 
Full fee[D]: $169. 

CDT code: D2391; 
Description: Resin-Based Composite One Surface, Posterior; 
Local dentist fee: 
Midpoint[A]: $160; 
Upper-end[B]: $195; 
Health center fee: 
100 FPL[C]: $93.5; 
Full fee[D]: $187. 

CDT code: D2392; 
Description: Resin-Based Composite-Two Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $206; 
Upper-end[B]: $266; 
Health center fee: 
100 FPL[C]: $131.5; 
Full fee[D]: $263. 

CDT code: D2393; 
Description: Resin-Based Composite-Three Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $255; 
Upper-end[B]: $328; 
Health center fee: 
100 FPL[C]: $163.5; 
Full fee[D]: $327. 

CDT code: D2950; 
Description: Core Buildup, Including Any Pins; 
Local dentist fee: 
Midpoint[A]: $250; 
Upper-end[B]: $309; 
Health center fee: 
100 FPL[C]: $138.5; 
Full fee[D]: $277. 

Endodontics: 

CDT code: D3310; 
Description: Endodontic Therapy, Anterior Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $700; 
Upper-end[B]: $825; 
Health center fee: 
100 FPL[C]: $400; 
Full fee[D]: $800. 

CDT code: D3320; 
Description: Endodontic Therapy, Bicuspid Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $750; 
Upper-end[B]: $955; 
Health center fee: 
100 FPL[C]: $437.5; 
Full fee[D]: $875. 

CDT code: D3330; 
Description: Endodontic Therapy, Molar (Excluding Final Restoration); 
Local dentist fee: 
Midpoint[A]: $1,100; 
Upper-end[B]: $1,169; 
Health center fee: 
100 FPL[C]: $578.5; 
Full fee[D]: $1,157. 

Periodontics: 

CDT code: D4341; 
Description: Periodontal Scaling and Root Planing-Four or More Teeth 
per Quadrant; 
Local dentist fee: 
Midpoint[A]: $236; 
Upper-end[B]: $305; 
Health center fee: 
100 FPL[C]: $172.5; 
Full fee[D]: $345. 

CDT code: D4381; 
Description: Localized Delivery of Antimicrobial Agents via a 
Controlled Release Vehicle Into Diseased Crevicular Tissue, per Tooth, 
by Report; 
Local dentist fee: 
Midpoint[A]: $49; 
Upper-end[B]: $60; 
Health center fee: 
100 FPL[C]: $e; 
Full fee[D]: $e. 

CDT code: D4910; 
Description: Periodontal Maintenance; 
Local dentist fee: 
Midpoint[A]: $130; 
Upper-end[B]: $159; 
Health center fee: 
100 FPL[C]: $69; 
Full fee[D]: $138. 

Oral surgery: 

CDT code: D7140; 
Description: Extraction, Erupted Tooth or Exposed Root (Elevation 
and/or Forceps Removal); 
Local dentist fee: 
Midpoint[A]: $149; 
Upper-end[B]: $185; 
Health center fee: 
100 FPL[C]: $89.5; 
Full fee[D]: $179. 

CDT code: D7210; 
Description: Surgical Removal of Erupted Tooth Requiring Removal of 
Bone and/or Sectioning of Tooth, and Including Elevation of the 
Mucoperlosteal Flap if Indicated; 
Local dentist fee: 
Midpoint[A]: $250; 
Upper-end[B]: $319; 
Health center fee: 
100 FPL[C]: $142.5; 
Full fee[D]: $285. 

CDT code: D7240; 
Description: Removal of Impacted Tooth-Completely Bony; 
Local dentist fee: 
Midpoint[A]: $350; 
Upper-end[B]: $395; 
Health center fee: 
100 FPL[C]: [E]; 
Full fee[D]: [E]. 

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 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. 

[End of table] 

Table 12: Dental Fees Charged for Common Procedures in Los Angeles, 
California (900), 2012: 

Diagnostic: 

CDT code: D0120; 
Description: Periodic Oral Evaluation-Established Patient; 
Local dentist fee: 
Midpoint[A]: $63; 
Upper-end[B]: $110; 
100% FPL[C]: $0; 
Full fee[D]: $150. 

CDT code: D0150; 
Description: Comprehensive Oral Evaluation-New or Established Patient; 
Local dentist fee: 
Midpoint[A]: $89; 
Upper-end[B]: $150; 
100% FPL[C]: $0; 
Full fee[D]: $200. 

CDT code: D0220; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical 
First Film; 
Local dentist fee: 
Midpoint[A]: $30; 
Upper-end[B]: $50; 
100% FPL[C]: [E]; 
Full fee[D]: [E]. 

CDT code: D0230; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical Each 
Additional Film; 
Local dentist fee: 
Midpoint[A]: $20; 
Upper-end[B]: $40; 
Health center fee: 
100% FPL[C]: [E]; 
Full fee[D]: [E]. 

CDT code: D0274; 
Description: Radiographs/Diagnostic Imaging: Bitewings-Four Films; 
Local dentist fee: 
Midpoint[A]: $70; 
Upper-end[B]: $100; 
Health center fee: 
100% FPL[C]: [E]; 
Full fee[D]: [E]. 

Preventive: 

CDT code: D1110; 
Description: Prophylaxis-Adult; 
Local dentist fee: 
Midpoint[A]: $100; 
Upper-end[B]: $150; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $120. 

CDT code: D1120; 
Description: Prophylaxis-Child; 
Local dentist fee: 
Midpoint[A]: $85; 
Upper-end[B]: $120; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $90. 

CDT code: D1203; 
Description: Topical Application of Fluoride-Child; 
Local dentist fee: 
Midpoint[A]: $40; 
Upper-end[B]: $90; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $54. 

CDT code: D1204; 
Description: Topical Application of Fluoride-Adult; 
Local dentist fee: 
Midpoint[A]: $40; 
Upper-end[B]: $80; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $18. 

CDT code: D1351; 
Description: Sealant-per Tooth; 
Local dentist fee: 
Midpoint[A]: $66; 
Upper-end[B]: $102; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $66. 

Restorative: 

CDT code: D2330; 
Description: Resin-Based Composite-One Surface, Anterior; 
Local dentist fee: 
Midpoint[A]: $163; 
Upper-end[B]: $290; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $165. 

CDT code: D2391; 
Description: Resin-Based Composite-One Surface, Posterior; 
Local dentist fee: 
Midpoint[A]: $185; 
Upper-end[B]: $300; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $117. 

CDT code: D2392; 
Description: Resin-Based Composite-Two Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $237; 
Upper-end[B]: $365; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $144. 

CDT code: D2393; 
Description: Resin-Based Composite-Three Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $280; 
Upper-end[B]: $414; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $171. 

CDT code: D2950; 
Description: Core Buildup, Including Any Pins; 250; 
Upper-end[B]: $390; 
Health center fee: 
100% FPL[C]: [E]; 
Full fee[D]: [E]. 

Endodontics: 
CDT code: D3310; 
Description: Endodontic Therapy, Anterior Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $690; 
Upper-end[B]: $1200; 
Health center fee: 
100% FPL[C]: [E]; 
Full fee[D]: [E]. 

CDT code: D3320; 
Description: Endodontic Therapy, Bicuspid Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $800; 
Upper-end[B]: $1400; 
Health center fee: 
100% FPL[C]: [E]; 
Full fee[D]: [E]. 

CDT code: D3330; 
Description: Endodontic Therapy, Molar (Excluding Final Restoration); 
Local dentist fee: 
Local dentist fee: 
Midpoint[A]: $1,000; 
Upper-end[B]: $1,700; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $500. 

Periodontics: 

CDT code: D4341; 
Description: Periodontal Scaling and Root Planing-Four or More Teeth 
per Quadrant; 
Local dentist fee: 
Midpoint[A]: $240; 
Upper-end[B]: $350; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $84. 

CDT code: D4381; 
Description: Localized Delivery of Antimicrobial Agents via a 
Controlled Release Vehicle Into Diseased Crevicular Tissue, per Tooth, 
by Report; 
Local dentist fee: 
Midpoint[A]: $80; 
Upper-end[B]: $194; 
Health center fee: 
100% FPL[C]: [E]; 
Full fee[D]: [E]. 

CDT code: D4910; 
Description: Periodontal Maintenance; 
Local dentist fee: 
Midpoint[A]: $45; 
Upper-end[B]: $195; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $72. 

Oral surgery: 

CDT code: D7140; 
Description: Extraction, Erupted Tooth or Exposed Root (Elevation 
and/or Forceps Removal); 
Local dentist fee: 
Midpoint[A]: $157; 
Upper-end[B]: $300; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $54. 

CDT code: D7210; 
Description: Surgical Removal of Erupted Tooth Requiring Removal of 
Bone and/or Sectioning of Tooth, and Including Elevation of the 
Mucoperlosteal Flap if Indicated; 
Local dentist fee: 
Midpoint[A]: $275; 
Upper-end[B]: $495; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $96. 

CDT code: D7240; 
Description: Removal of Impacted Tooth-Completely Bony; 
Local dentist fee: 
Midpoint[A]: $450; 
Upper-end[B]: $754; 
Health center fee: 
100% FPL[C]: [E]; 
Full fee[D]: [E]. 

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 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. 

[End of table] 

Table 13: Dental Fees Charged for Common Procedures in Fresno, 
California (936), 2012: 

Diagnostic: 

CDT code: D0120; 
Description: Periodic Oral Evaluation-Established Patient; 
Local dentist fee: 
Midpoint[A]: $45; 
Upper-end[B]: $66; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $53. 

CDT code: D0150; 
Description: Comprehensive Oral Evaluation-New or Established Patient; 
Local dentist fee:
Midpoint[A]: $72; 
Upper-end[B]: $107; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $93. 

CDT code: D0220; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical 
First Film; 
Local dentist fee:
Midpoint[A]: $27; 
Upper-end[B]: $40; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $30. 

CDT code: D0230; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical Each 
Additional Film; 
Local dentist fee:
Midpoint[A]: $17; 
Upper-end[B]: $30; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $26. 

CDT code: D0274; 
Description: Radiographs/Diagnostic Imaging: Bitewings-Four Films; 
Midpoint[A]: $45: 72: 27: 17: 60; 
Upper-end[B]: $83; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $68. 

Preventive: 

CDT code: D1110; 
Description: Prophylaxis-Adult; 
Local dentist fee:
Midpoint[A]: $88; 
Upper-end[B]: $108; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $95. 

CDT code: D1120; 
Description: Prophylaxis-Child; 
Local dentist fee:
Midpoint[A]: $71; 
Upper-end[B]: $91; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $71. 

CDT code: D1203; 
Description: Topical Application of Fluoride-Child; 
Local dentist fee:
Midpoint[A]: $30; 
Upper-end[B]: $50; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $39. 

CDT code: D1204; 
Description: Topical Application of Fluoride-Adult; 
Local dentist fee:
Midpoint[A]: $31; 
Upper-end[B]: $50; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $39. 

CDT code: D1351; 
Description: Sealant-per Tooth; 
Local dentist fee:
Midpoint[A]: $50; 
Upper-end[B]: $75; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $57. 

Restorative: 

CDT code: D2330; 
Description: Resin-Based Composite-One Surface, Anterior; 
Local dentist fee:
Midpoint[A]: $148; 
Upper-end[B]: $194; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $171. 

CDT code: D2391; 
Description: Resin-Based Composite-One Surface, Posterior; 
Local dentist fee:
Midpoint[A]: $160; 
Upper-end[B]: $225; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $189. 

CDT code: D2392; 
Description: Resin-Based Composite-Two Surfaces, Posterior; 
Local dentist fee:
Midpoint[A]: $208; 
Upper-end[B]: $288; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $246. 

CDT code: D2393; 
Description: Resin-Based Composite-Three Surfaces, Posterior; 
Local dentist fee:
Midpoint[A]: $248; 
Upper-end[B]: $364; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $303. 

CDT code: D2950; 
Description: Core Buildup, Including Any Pins; 
Local dentist fee:
Midpoint[A]: $225; 
Upper-end[B]: $325; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $289. 

Endodontics: 

CDT code: D3310; 
Description: Endodontic Therapy, Anterior Tooth (Excluding Final 
Restoration); 
Local dentist fee:
Midpoint[A]: $650; 
Upper-end[B]: $895; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $785. 

CDT code: D3320; 
Description: Endodontic Therapy, Bicuspid Tooth (Excluding Final 
Restoration); 
Local dentist fee:
Midpoint[A]: $775; 
Upper-end[B]: $979; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $905. 

CDT code: D3330; 
Description: Endodontic Therapy, Molar (Excluding Final Restoration); 
Local dentist fee:
Midpoint[A]: $1,013; 
Upper-end[B]: $1,218; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $1,095. 

Periodontics: 

CDT code: D4341; 
Description: Periodontal Scaling and Root Planing-Four or More Teeth 
per Quadrant; 
Local dentist fee:
Midpoint[A]: $225; 
Upper-end[B]: $311; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $269. 

CDT code: D4381; 
Description: Localized Delivery of Antimicrobial Agents via a 
Controlled Release Vehicle Into Diseased Crevicular Tissue, per Tooth, 
by Report; 
Local dentist fee:
Midpoint[A]: $91; 
Upper-end[B]: $150; 
Health center fee: 
100% FPL[C]: [E]; 
Full fee[D]: [E]. 

CDT code: D4910; 
Description: Periodontal Maintenance; 
Local dentist fee:
Midpoint[A]: $138; 
Upper-end[B]: $173; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $147. 

Oral surgery: 

CDT code: D7140; 
Description: Extraction, Erupted Tooth or Exposed Root (Elevation 
and/or Forceps Removal); 
Local dentist fee:
Midpoint[A]: $142; 
Upper-end[B]: $214; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $188. 

CDT code: D7210; 
Description: Surgical Removal of Erupted Tooth Requiring Removal of 
Bone and/or Sectioning of Tooth, and Including Elevation of the 
Mucoperlosteal Flap if Indicated; 
Local dentist fee:
Midpoint[A]: $250; 
Upper-end[B]: $351; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $294. 

CDT code: D7240; 
Description: Removal of Impacted Tooth-Completely Bony; 
Local dentist fee: 
Midpoint[A]: $385; 
Upper-end[B]: 499; 
Health center fee: 
100% FPL[C]: [E]; 
Full fee[D]: [E]. 

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 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. 

[End of table] 

Table 14: Dental Fees Charged for Common Procedures in Miami, Florida 
(331), 2012: 

Diagnostic: 

CDT code: D0120; 
Description: Periodic Oral Evaluation-Established Patient; 
Local dentist fee: 
Midpoint[A]: $62; 
Health center fee: 
Upper-end[B]: $150; 
100% FPL[C]: $20; 
Full fee[D]: $49. 

CDT code: D0150; 
Description: Comprehensive Oral Evaluation-New or Established Patient; 
Local dentist fee: 
Midpoint[A]: $85; 
Health center fee: 
Upper-end[B]: $150; 
100% FPL[C]: $30; 
Full fee[D]: $85. 

CDT code: D0220; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical 
First Film; 
Local dentist fee: 
Midpoint[A]: $25; 
Health center fee: 
Upper-end[B]: $50; 
100% FPL[C]: $10; 
Full fee[D]: $28. 

CDT code: D0230; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical Each 
Additional Film; 
Local dentist fee: 
Midpoint[A]: $22; 
Health center fee: 
Upper-end[B]: $50; 
100% FPL[C]: $10; 
Full fee[D]: $24. 

CDT code: D0274; 
Description: Radiographs/Diagnostic Imaging: Bitewings-Four Films; 
Midpoint[A]: $66; 
Health center fee: 
Upper-end[B]: $140; 
100% FPL[C]: $20; 
Full fee[D]: $62. 

Preventive: 

CDT code: D1110; 
Description: Prophylaxis-Adult; 
Local dentist fee: 
Midpoint[A]: $95; 
Health center fee: 
Upper-end[B]: $150; 
100% FPL[C]: $35; 
Full fee[D]: $90. 

CDT code: D1120; 
Description: Prophylaxis-Child; 
Local dentist fee: 
Midpoint[A]: $75; 
Health center fee: 
Upper-end[B]: $120; 
100% FPL[C]: $25; 
Full fee[D]: $65. 

CDT code: D1203; 
Description: Topical Application of Fluoride-Child; 
Local dentist fee: 
Midpoint[A]: $32; 
Health center fee: 
Upper-end[B]: $60; 
100% FPL[C]: $10; 
Full fee[D]: $35. 

CDT code: D1204; 
Description: Topical Application of Fluoride-Adult; 
Local dentist fee: 
Midpoint[A]: $49; 
Health center fee: 
Upper-end[B]: $85; 
100% FPL[C]: $10; 
Full fee[D]: $36. 

CDT code: D1351; 
Description: Sealant-per Tooth; 
Local dentist fee: 
Midpoint[A]: $47; 
Health center fee: 
Upper-end[B]: $80; 
100% FPL[C]: $20; 
Full fee[D]: $54. 

Restorative: 

CDT code: D2330; 
Description: Resin-Based Composite-One Surface, Anterior; 
Local dentist fee: 
Midpoint[A]: $154; 
Health center fee: 
Upper-end[B]: $250; 
100% FPL[C]: $55; 
Full fee[D]: $160. 

CDT code: D2391; 
Description: Resin-Based Composite-One Surface, Posterior; 
Local dentist fee: 
Midpoint[A]: $170; 
Health center fee: 
Upper-end[B]: $270; 
100% FPL[C]: $60; 
Full fee[D]: $175. 

CDT code: D2392; 
Description: Resin-Based Composite-Two Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $200; 
Health center fee: 
Upper-end[B]: $320; 
100% FPL[C]: $75; 
Full fee[D]: $225. 

CDT code: D2393; 
Description: Resin-Based Composite-Three Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $255; 
Health center fee: 
Upper-end[B]: $400; 
100% FPL[C]: $90; 
Full fee[D]: $279. 

CDT code: D2950; 
Description: Core Buildup, Including Any Pins; 
Local dentist fee: 
Midpoint[A]: $250; 
Health center fee: 
Upper-end[B]: $400; 
100% FPL[C]: $100; 
Full fee[D]: $264. 

Endodontics: 

CDT code: D3310; 
Description: Endodontic Therapy, Anterior Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $850; 
Health center fee: 
Upper-end[B]: $1,400; 
100% FPL[C]: $400; 
Full fee[D]: $700. 

CDT code: D3320; 
Description: Endodontic Therapy, Bicuspid Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $935; 
Health center fee: 
Upper-end[B]: $1,545; 
100% FPL[C]: $500; 
Full fee[D]: $814. 

CDT code: D3330; 
Description: Endodontic Therapy, Molar (Excluding Final Restoration); 
Local dentist fee: 
Midpoint[A]: $1,163; 
Health center fee: 
Upper-end[B]: $1,760; 
100% FPL[C]: $600; 
Full fee[D]: $977. 

Periodontics: 

CDT code: D4341; 
Description: Periodontal Scaling and Root Planing-Four or More Teeth 
per Quadrant; 
Local dentist fee: 
Midpoint[A]: $245; 
Health center fee: 
Upper-end[B]: $384; 
100% FPL[C]: $70; 
Full fee[D]: $241. 

CDT code: D4381; 
Description: Localized Delivery of Antimicrobial Agents via a 
Controlled Release Vehicle Into Diseased Crevicular Tissue, per Tooth, 
by Report; 
Local dentist fee: 
Midpoint[A]: $60; 
Health center fee: 
Upper-end[B]: $125; 
100% FPL[C]: [E]; 
Full fee[D]: [E]. 

CDT code: D4910; 
Description: Periodontal Maintenance; 
Local dentist fee: 
Midpoint[A]: $128; 
Health center fee: 
Upper-end[B]: $195; 
100% FPL[C]: $55; 
Full fee[D]: $135. 

Oral surgery: 

CDT code: D7140; 
Description: Extraction, Erupted Tooth or Exposed Root (Elevation 
and/or Forceps Removal); 
Local dentist fee: 
Midpoint[A]: $165; 
Health center fee: 
Upper-end[B]: $325; 
100% FPL[C]: $70; 
Full fee[D]: $166. 

CDT code: D7210; 
Description: Surgical Removal of Erupted Tooth Requiring Removal of 
Bone and/or Sectioning of Tooth, and Including Elevation of the 
Mucoperlosteal Flap if Indicated; 
Local dentist fee: 
Midpoint[A]: $275; 
Health center fee: 
Upper-end[B]: $500; 
100% FPL[C]: $110; 
Full fee[D]: $273. 

CDT code: D7240; 
Description: Removal of Impacted Tooth-Completely Bony; 
Local dentist fee: 
Midpoint[A]: $460; 
Health center fee: 
Upper-end[B]: 750; 
100% FPL[C]: [E]; 
Full fee[D]: [E]. 

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 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. 

[End of table] 

Table 15: Dental Fees Charged for Common Procedures in Palm Coast, 
Florida (321), 2012: 

Diagnostic: 

CDT code: D0120; 
Description: Periodic Oral Evaluation-Established Patient; 
Local dentist fee: 
Midpoint[A]: $36; 
Upper end[B]: $49; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $52. 

CDT code: D0150; 
Description: Comprehensive Oral Evaluation-New or Established Patient; 
Local dentist fee: 
Midpoint[A]: $65; 
Upper end[B]: 88; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $84. 

CDT code: D0220; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical 
First Film; 
Local dentist fee: 
Midpoint[A]: $20; 
Upper end[B]: 28; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $26. 

CDT code: D0230; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical Each 
Additional Film; 
Local dentist fee: 
Midpoint[A]: $13; 
Upper end[B]: 24; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $22. 

CDT code: D0274; 
Description: Radiographs/Diagnostic Imaging: Bitewings-Four Films; 
Local dentist fee: 
Midpoint[A]: $46; 
Upper end[B]: 62; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $56. 

Preventive: 

CDT code: D1110; 
Description: Prophylaxis-Adult; 
Local dentist fee: 
Midpoint[A]: $72; 
Upper end[B]: 87; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $84. 

CDT code: D1120; 
Description: Prophylaxis-Child; 
Local dentist fee: 
Midpoint[A]: $57; 
Upper end[B]: 65; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $60. 

CDT code: D1203; 
Description: Topical Application of Fluoride-Child; 
Local dentist fee: 
Midpoint[A]: $34; 
Upper end[B]: 36; 
Health center fee: 
100% FPL[C]: [E]; 
Full fee[D]: [E]. 

CDT code: D1204; 
Description: Topical Application of Fluoride-Adult; 
Local dentist fee: 
Midpoint[A]: $25; 
Upper end[B]: 37; 
Health center fee: 
100% FPL[C]: [E]; 
Full fee[D]: [E]. 

CDT code: D1351; 
Description: Sealant-per Tooth; 
Local dentist fee: 
Midpoint[A]: $45; 
Upper end[B]: 58; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $42. 

Restorative: 

CDT code: D2330; 
Description: Resin-Based Composite-One Surface, Anterior; 
Local dentist fee: 
Midpoint[A]: $120; 
Upper end[B]: 175; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $130. 

CDT code: D2391; 
Description: Resin-Based Composite-One Surface, Posterior; 
Local dentist fee: 
Midpoint[A]: $140; 
Upper end[B]: 191; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $152. 

CDT code: D2392; 
Description: Resin-Based Composite-Two Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $175; 
Upper end[B]: 231; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $196. 

CDT code: D2393; 
Description: Resin-Based Composite-Three Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $195; 
Upper end[B]: 291; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $248. 

CDT code: D2950; 
Description: Core Buildup, Including Any Pins; 
Local dentist fee: 
Midpoint[A]: $210; 
Upper end[B]: 283; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $264. 

Endodontics: 

CDT code: D3310; 
Description: Endodontic Therapy, Anterior Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $685; 
Upper end[B]: 845; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $650. 

CDT code: D3320; 
Description: Endodontic Therapy, Bicuspid Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $795; 
Upper end[B]: 990; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $768. 

CDT code: D3330; 
Description: Endodontic Therapy, Molar (Excluding Final Restoration); 
Local dentist fee: 
Midpoint[A]: $940; 
Upper end[B]: 1,200; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $988. 

Periodontics: 

CDT code: D4341; 
Description: Periodontal Scaling and Root Planing-Four or More Teeth 
per Quadrant; 
Local dentist fee: 
Midpoint[A]: $183; 
Upper end[B]: 250; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $244. 

CDT code: D4381; 
Description: Localized Delivery of Antimicrobial Agents via a 
Controlled Release Vehicle Into Diseased Crevicular Tissue, per Tooth, 
by Report; 
Local dentist fee: 
Midpoint[A]: $59; 
Upper end[B]: 95; 
Health center fee: 
100% FPL[C]: [E]; 
Full fee[D]: [E]. 

CDT code: D4910; 
Description: Periodontal Maintenance; 
Local dentist fee: 
Midpoint[A]: $100; 
Upper end[B]: 133; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $140. 

Oral surgery: 

CDT code: D7140; 
Description: Extraction, Erupted Tooth or Exposed Root (Elevation 
and/or Forceps Removal); 
Local dentist fee: 
Midpoint[A]: $135; 
Upper end[B]: 200; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $134. 

CDT code: D7210; 
Description: Surgical Removal of Erupted Tooth Requiring Removal of 
Bone and/or Sectioning of Tooth, and Including Elevation of the 
Mucoperlosteal Flap if Indicated; 
Local dentist fee: 
Midpoint[A]: $219; 
Upper end[B]: 299; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $248. 

CDT code: D7240; 
Description: Removal of Impacted Tooth-Completely Bony; 
Local dentist fee: 
Midpoint[A]: $436; 
Upper end[B]: 515; 
Health center fee: 
100% FPL[C]: [E]; 
Full fee[D]: [E]. 

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 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. 

[End of table] 

Table 16: Dental Fees Charged for Common Procedures in Chicago, 
Illinois (606), 2012: 

Diagnostic: 

CDT code: D0120; 
Description: Periodic Oral Evaluation-Established Patient; 
Local dentist fee: 
Midpoint[A]: $49; 
Upper-end[B]: $72; 
Health center fee: 
100% FPL[C]: $30; 
Full fee[D]: $35. 

CDT code: D0150; 
Description: Comprehensive Oral Evaluation-New or Established Patient; 
Local dentist fee: 
Midpoint[A]: $75; 
Upper-end[B]: $114; 
Health center fee: 
100% FPL[C]: $30; 
Full fee[D]: $50. 

CDT code: D0220; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical 
First Film; 
Local dentist fee: 
Midpoint[A]: $25; 
Upper-end[B]: $40; 
Health center fee: 
100% FPL[C]: $30; 
Full fee[D]: $19. 

CDT code: D0230; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical Each 
Additional Film; 
Local dentist fee: 
Midpoint[A]: $20; 
Upper-end[B]: $35; 
Health center fee: 
100% FPL[C]: $30; 
Full fee[D]: $19. 

CDT code: D0274; 
Description: Radiographs/Diagnostic Imaging: Bitewings-Four Films; 
Local dentist fee: 
Midpoint[A]: $60; 
Upper-end[B]: 83; 
Health center fee: 
100% FPL[C]: $30; 
Full fee[D]: $50. 

Preventive: 

CDT code: D1110; 
Description: Prophylaxis-Adult; 
Local dentist fee: 
Midpoint[A]: $90; 
Upper-end[B]: $120; 
Health center fee: 
100% FPL[C]: $30; 
Full fee[D]: $72. 

CDT code: D1120; 
Description: Prophylaxis-Child; 
Local dentist fee: 
Midpoint[A]: $65; 
Upper-end[B]: $87; 
Health center fee: 
100% FPL[C]: $30; 
Full fee[D]: $53. 

CDT code: D1203; 
Description: Topical Application of Fluoride-Child; 
Local dentist fee: 
Midpoint[A]: $35; 
Upper-end[B]: $51; 
Health center fee: 
100% FPL[C]: $30; 
Full fee[D]: $28. 

CDT code: D1204; 
Description: Topical Application of Fluoride-Adult; 
Local dentist fee: 
Midpoint[A]: $30; 
Upper-end[B]: $50; 
Health center fee: 
100% FPL[C]: $30; 
Full fee[D]: $28. 

CDT code: D1351; 
Description: Sealant-per Tooth; 
Local dentist fee: 
Midpoint[A]: $52; 
Upper-end[B]: $72; 
Health center fee: 
100% FPL[C]: $30; 
Full fee[D]: $39. 

Restorative: 

CDT code: D2330; 
Description: Resin-Based Composite-One Surface, Anterior; 
Local dentist fee: 
Midpoint[A]: $150; 
Upper-end[B]: $225; 
Health center fee: 
100% FPL[C]: $30; 
Full fee[D]: $99. 

CDT code: D2391; 
Description: Resin-Based Composite-One Surface, Posterior; 
Local dentist fee: 
Midpoint[A]: $160; 
Upper-end[B]: $235; 
Health center fee: 
100% FPL[C]: $30; 
Full fee[D]: $110. 

CDT code: D2392; 
Description: Resin-Based Composite-Two Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $205; 
Upper-end[B]: $290; 
Health center fee: 
100% FPL[C]: $30; 
Full fee[D]: $145. 

CDT code: D2393; 
Description: Resin-Based Composite-Three Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $236; 
Upper-end[B]: $350; 
Health center fee: 
100% FPL[C]: $30; 
Full fee[D]: $175. 

CDT code: D2950; 
Description: Core Buildup, Including Any Pins; 
Local dentist fee: 
Midpoint[A]: $250; 
Upper-end[B]: $367; 
Health center fee: 
100% FPL[C]: $30; 
Full fee[D]: $195. 

Endodontics: 

CDT code: D3310; 
Description: Endodontic Therapy, Anterior Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $700; 
Upper-end[B]: $1025; 
Health center fee: 
100% FPL[C]: $30; 
Full fee[D]: $495. 

CDT code: D3320; 
Description: Endodontic Therapy, Bicuspid Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $800; 
Upper-end[B]: $1,200; 
Health center fee: 
100% FPL[C]: $30; 
Full fee[D]: $590. 

CDT code: D3330; 
Description: Endodontic Therapy, Molar (Excluding Final Restoration); 
Local dentist fee: 
Midpoint[A]: $1,000; 
Upper-end[B]: 1,500; 
Health center fee: 
100% FPL[C]: $30; 
Full fee[D]: $710. 

Periodontics: 

CDT code: D4341; 
Description: Periodontal Scaling and Root Planing-Four or More Teeth 
per Quadrant; 
Local dentist fee: 
Midpoint[A]: $222; 
Upper-end[B]: $300; 
Health center fee: 
100% FPL[C]: $30; 
Full fee[D]: $185. 

CDT code: D4381; 
Description: Localized Delivery of Antimicrobial Agents via a 
Controlled Release Vehicle Into Diseased Crevicular Tissue, per Tooth, 
by Report; 
Local dentist fee: 
Midpoint[A]: $40; 
Upper-end[B]: $83; 
Health center fee: 
100% FPL[C]: [E]; 
Full fee[D]: [E]. 

CDT code: D4910; 
Description: Periodontal Maintenance; 
Local dentist fee: 
Midpoint[A]: $131; 
Upper-end[B]: $176; 
Health center fee: 
100% FPL[C]: $30; 
Full fee[D]: $119. 

Oral surgery: 

CDT code: D7140; 
Description: Extraction, Erupted Tooth or Exposed Root (Elevation 
and/or Forceps Removal); 
Local dentist fee: 
Midpoint[A]: $150; 
Upper-end[B]: $240; 
Health center fee: 
100% FPL[C]: $30; 
Full fee[D]: $105. 

CDT code: D7210; 
Description: Surgical Removal of Erupted Tooth Requiring Removal of 
Bone and/or Sectioning of Tooth, and Including Elevation of the 
Mucoperlosteal Flap if Indicated; 
Local dentist fee: 
Midpoint[A]: $260; 
Upper-end[B]: $390; 
Health center fee: 
100% FPL[C]: $30; 
Full fee[D]: $262. 

CDT code: D7240; 
Description: Removal of Impacted Tooth-Completely Bony; 
Local dentist fee: 
Midpoint[A]: $500; 
Upper-end[B]: $661; 
Health center fee: 
100% FPL[C]: [E]; 
Full fee[D]: [E]. 

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 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. 

[End of table] 

Table 17: Dental Fees Charged for Common Procedures in Champaign, 
Illinois (618), 2012: 

Diagnostic: 

CDT code: D0120; 
Description: Periodic Oral Evaluation-Established Patient; 
Local dentist fee: 
Midpoint[A]: $40; 
Upper-end[B]: $50; 
Health center fee: 
100% FPL[C]: $20; 
Full fee[D]: $28. 

CDT code: D0150; 
Description: Comprehensive Oral Evaluation-New or Established Patient; 
Local dentist fee: 
Midpoint[A]: $77; 
Upper-end[B]: $87; 
Health center fee: 
100% FPL[C]: $40; 
Full fee[D]: $55. 

CDT code: D0220; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical 
First Film; 
Local dentist fee: 
Midpoint[A]: $26; 
Upper-end[B]: $31; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: $20. 

CDT code: D0230; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical Each 
Additional Film; 
Local dentist fee: 
Midpoint[A]: $21; 
Upper-end[B]: $26; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: $16. 

CDT code: D0274; 
Description: Radiographs/Diagnostic Imaging: Bitewings-Four Films; 
Midpoint[A]: $40: 77: 26: 21: 59; 
Upper-end[B]: $70; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: $43. 

Preventive: 

CDT code: D1110; 
Description: Prophylaxis-Adult; 
Local dentist fee: 
Midpoint[A]: $78; 
Upper-end[B]: $91; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: $60. 

CDT code: D1120; 
Description: Prophylaxis-Child; 
Local dentist fee: 
Midpoint[A]: $61; 
Upper-end[B]: $67; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: $45. 

CDT code: D1203; 
Description: Topical Application of Fluoride-Child; 
Local dentist fee: 
Midpoint[A]: $31; 
Upper-end[B]: $38; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: $27. 

CDT code: D1204; 
Description: Topical Application of Fluoride-Adult; 
Local dentist fee: 
Midpoint[A]: $31; 
Upper-end[B]: $39; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: $28. 

CDT code: D1351; 
Description: Sealant-per Tooth; 
Local dentist fee: 
Midpoint[A]: $51; 
Upper-end[B]: $57; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: $40. 

Restorative: 

CDT code: D2330; 
Description: Resin-Based Composite-One Surface, Anterior; 
Local dentist fee: 
Midpoint[A]: $133; 
Upper-end[B]: $163; 
Health center fee: 
100% FPL[C]: $40; 
Full fee[D]: $98. 

CDT code: D2391; 
Description: Resin-Based Composite-One Surface, Posterior; 
Local dentist fee: 
Midpoint[A]: $152; 
Upper-end[B]: $180; 
Health center fee: 
100% FPL[C]: $40; 
Full fee[D]: $109. 

CDT code: D2392; 
Description: Resin-Based Composite-Two Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $208; 
Upper-end[B]: $235; 
Health center fee: 
100% FPL[C]: $40; 
Full fee[D]: $141. 

CDT code: D2393; 
Description: Resin-Based Composite-Three Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $252; 
Upper-end[B]: $290; 
Health center fee: 
100% FPL[C]: $40; 
Full fee[D]: $177. 

CDT code: D2950; 
Description: Core Buildup, Including Any Pins; 
Local dentist fee: 
Midpoint[A]: $271; 
Upper-end[B]: $281; 
Health center fee: 
100% FPL[C]: $40; 
Full fee[D]: $175. 

Endodontics: 

CDT code: D3310; 
Description: Endodontic Therapy, Anterior Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $726; 
Upper-end[B]: $795; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: $517. 

CDT code: D3320; 
Description: Endodontic Therapy, Bicuspid Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $836; 
Upper-end[B]: $895; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: $449. 

CDT code: D3330; 
Description: Endodontic Therapy, Molar (Excluding Final Restoration); 
Local dentist fee: 
Midpoint[A]: $1,005; 
Upper-end[B]: $1,025; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: $549. 

Periodontics: 

CDT code: D4341; 
Description: Periodontal Scaling and Root Planing-Four or More Teeth 
per Quadrant; 
Local dentist fee: 
Midpoint[A]: $246; 
Upper-end[B]: $294; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: $196. 

CDT code: D4381; 
Description: Localized Delivery of Antimicrobial Agents via a 
Controlled Release Vehicle Into Diseased Crevicular Tissue, per Tooth, 
by Report; 
Local dentist fee: 
Midpoint[A]: $69; 
Upper-end[B]: $104; 
Health center fee: 
100% FPL[C]: [E]; 
Full fee[D]: [E]. 

CDT code: D4910; 
Description: Periodontal Maintenance; 
Local dentist fee: 
Midpoint[A]: $129; 
Upper-end[B]: $143; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: $109. 

Oral surgery: 

CDT code: D7140; 
Description: Extraction, Erupted Tooth or Exposed Root (Elevation 
and/or Forceps Removal); 
Local dentist fee: 
Midpoint[A]: $159; 
Upper-end[B]: $190; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: $106. 

CDT code: D7210; 
Description: Surgical Removal of Erupted Tooth Requiring Removal of 
Bone and/or Sectioning of Tooth, and Including Elevation of the 
Mucoperlosteal Flap if Indicated; 
Local dentist fee: 
Midpoint[A]: $258; 
Upper-end[B]: $301; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: $209. 

CDT code: D7240; 
Description: Removal of Impacted Tooth-Completely Bony; 
Local dentist fee: 
Midpoint[A]: $471; 
Upper-end[B]: 525; 
Health center fee: 
100% FPL[C]: [E]; 
Full fee[D]: [E]. 

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 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. 

[End of table] 

Table 18: Dental Fees Charged for Common Procedures in Boston, 
Massachusetts (021), 2012: 

Diagnostic: 

CDT code: D0120; 
Description: Periodic Oral Evaluation-Established Patient; 
Local dentist fee: 
Midpoint[A]: $49; 
Upper-end[B]: $65; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $55. 

CDT code: D0150; 
Description: Comprehensive Oral Evaluation-New or Established Patient; 
Local dentist fee: 
Midpoint[A]: $86; 
Upper-end[B]: $150; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $88. 

CDT code: D0220; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical 
First Film; 
Local dentist fee: 
Midpoint[A]: $30; 
Upper-end[B]: 45; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $33. 

CDT code: D0230; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical Each 
Additional Film; 
Local dentist fee: 
Midpoint[A]: $25; 
Upper-end[B]: $40; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $24. 

CDT code: D0274; 
Description: Radiographs/Diagnostic Imaging: Bitewings-Four Films; 
Midpoint[A]: $49: 86: 30: 25: 70; 
Upper-end[B]: $95; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $74. 

Preventive: 

CDT code: D1110; 
Description: Prophylaxis-Adult; 
Local dentist fee: 
Midpoint[A]: $100; 
Upper-end[B]: $131; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $100. 

CDT code: D1120; 
Description: Prophylaxis-Child; 
Local dentist fee: 
Midpoint[A]: $78; 
Upper-end[B]: $115; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $63. 

CDT code: D1203; 
Description: Topical Application of Fluoride-Child; 
Local dentist fee: 
Midpoint[A]: $38; 
Upper-end[B]: $50; 
Health center fee: 
100% FPL[C]: $e; 
Full fee[D]: $e. 

CDT code: D1204; 
Description: Topical Application of Fluoride-Adult; 
Local dentist fee: 
Midpoint[A]: $38; 
Upper-end[B]: $53; 
Health center fee: 
100% FPL[C]: $e; 
Full fee[D]: $e. 

CDT code: D1351; 
Description: Sealant-per Tooth; 
Local dentist fee: 
Midpoint[A]: $65; 
Upper-end[B]: $92; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $51. 

Restorative: 

CDT code: D2330; 
Description: Resin-Based Composite-One Surface, Anterior; 
Local dentist fee: 
Midpoint[A]: $160; 
Upper-end[B]: $225; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $151. 

CDT code: D2391; 
Description: Resin-Based Composite-One Surface, Posterior; 
Local dentist fee: 
Midpoint[A]: $179; 
Upper-end[B]: $240; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $163. 

CDT code: D2392; 
Description: Resin-Based Composite-Two Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $225; 
Upper-end[B]: $301; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $212. 

CDT code: D2393; 
Description: Resin-Based Composite-Three Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $275; 
Upper-end[B]: $370; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $267. 

CDT code: D2950; 
Description: Core Buildup, Including Any Pins; 
Local dentist fee: 
Midpoint[A]: $340; 
Upper-end[B]: $460; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $260. 

Endodontics: 

CDT code: D3310; 
Description: Endodontic Therapy, Anterior Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $850; 
Upper-end[B]: $1,225; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $675. 

CDT code: D3320; 
Description: Endodontic Therapy, Bicuspid Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $1,050; 
Upper-end[B]: $1,325; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $785. 

CDT code: D3330; 
Description: Endodontic Therapy, Molar (Excluding Final Restoration); 
Local dentist fee: 
Midpoint[A]: $1,350; 
Upper-end[B]: $1,610; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $940. 

Periodontics: 

CDT code: D4341; 
Description: Periodontal Scaling and Root Planing-Four or More Teeth 
per Quadrant; 
Local dentist fee: 
Midpoint[A]: $251; 
Upper-end[B]: $345; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $234. 

CDT code: D4381; 
Description: Localized Delivery of Antimicrobial Agents via a 
Controlled Release Vehicle Into Diseased Crevicular Tissue, per Tooth, 
by Report; 
Local dentist fee: 
Midpoint[A]: $63; 
Upper-end[B]: $120; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $168. 

CDT code: D4910; 
Description: Periodontal Maintenance; 
Local dentist fee: 
Midpoint[A]: $140; 
Upper-end[B]: $184; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $128. 

Oral surgery: 

CDT code: D7140; 
Description: Extraction, Erupted Tooth or Exposed Root (Elevation 
and/or Forceps Removal); 
Local dentist fee: 
Midpoint[A]: $175; 
Upper-end[B]: $237; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $157. 

CDT code: D7210; 
Description: Surgical Removal of Erupted Tooth Requiring Removal of 
Bone and/or Sectioning of Tooth, and Including Elevation of the 
Mucoperlosteal Flap if Indicated; 
Local dentist fee: 
Midpoint[A]: $280; 
Upper-end[B]: $386; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $258. 

CDT code: D7240; 
Description: Removal of Impacted Tooth-Completely Bony; 
Local dentist fee: 
Midpoint[A]: $588; 
Upper-end[B]: $795; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $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] 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. 

[End of table] 

Table 19: Dental Fees Charged for Common Procedures in Pittsfield, 
Massachusetts (012), 2012: 

Diagnostic: 

CDT code: D0120; 
Description: Periodic Oral Evaluation-Established Patient; 
Local dentist fee: 
Midpoint[A]: $36; 
Upper-end[B]: $47; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $38. 

CDT code: D0150; 
Description: Comprehensive Oral Evaluation-New or Established Patient; 
Local dentist fee: 
Midpoint[A]: $68; 
Upper-end[B]: $103; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $51. 

CDT code: D0220; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical 
First Film; 
Local dentist fee: 
Midpoint[A]: $25; 
Upper-end[B]: $32; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $24. 

CDT code: D0230; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical Each 
Additional Film; 
Local dentist fee: 
Midpoint[A]: $22; 
Upper-end[B]: $30; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $20. 

CDT code: D0274; 
Description: Radiographs/Diagnostic Imaging: Bitewings-Four Films; 
Midpoint[A]: $36: 68: 25: 22: 58; 
Upper-end[B]: $76; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $54. 

Preventive: 

CDT code: D1110; 
Description: Prophylaxis-Adult; 
Local dentist fee: 
Midpoint[A]: $80; 
Upper-end[B]: $95; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $78. 

CDT code: D1120; 
Description: Prophylaxis-Child; 
Local dentist fee: 
Midpoint[A]: $56; 
Upper-end[B]: $73; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $56. 

CDT code: D1203; 
Description: Topical Application of Fluoride-Child; 
Local dentist fee: 
Midpoint[A]: $27; 
Upper-end[B]: $39; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $31. 

CDT code: D1204; 
Description: Topical Application of Fluoride-Adult; 
Local dentist fee: 
Midpoint[A]: $27; 
Upper-end[B]: $30; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $31. 

CDT code: D1351; 
Description: Sealant-per Tooth; 
Local dentist fee: 
Midpoint[A]: $49; 
Upper-end[B]: $54; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $46. 

Restorative: 

CDT code: D2330; 
Description: Resin-Based Composite-One Surface, Anterior; 
Local dentist fee: 
Midpoint[A]: $130; 
Upper-end[B]: $163; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $125. 

CDT code: D2391; 
Description: Resin-Based Composite-One Surface, Posterior; 
Local dentist fee: 
Midpoint[A]: $135; 
Upper-end[B]: $181; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $145. 

CDT code: D2392; 
Description: Resin-Based Composite-Two Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $179; 
Upper-end[B]: $242; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $190. 

CDT code: D2393; 
Description: Resin-Based Composite-Three Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $216; 
Upper-end[B]: $249; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $225. 

CDT code: D2950; 
Description: Core Buildup, Including Any Pins; 
Local dentist fee: 
Midpoint[A]: $265; 
Upper-end[B]: $309; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $230. 

Endodontics: 

CDT code: D3310; 
Description: Endodontic Therapy, Anterior Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $697; 
Upper-end[B]: $995; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $625. 

CDT code: D3320; 
Description: Endodontic Therapy, Bicuspid Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $875; 
Upper-end[B]: $1,140; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $735. 

CDT code: D3330; 
Description: Endodontic Therapy, Molar (Excluding Final Restoration); 
Local dentist fee: 
Midpoint[A]: $1,050; 
Upper-end[B]: $1,495; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $900. 

Periodontics: 

CDT code: D4341; 
Description: Periodontal Scaling and Root Planing-Four or More Teeth 
per Quadrant; 
Local dentist fee: 
Midpoint[A]: $241; 
Upper-end[B]: $290; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $215. 

CDT code: D4381; 
Description: Localized Delivery of Antimicrobial Agents via a 
Controlled Release Vehicle Into Diseased Crevicular Tissue, per Tooth, 
by Report; 
Local dentist fee: 
Midpoint[A]: $45; 
Upper-end[B]: $87; 
Health center fee: 
100% FPL[C]: $e; 
Full fee[D]: $e. 

CDT code: D4910; 
Description: Periodontal Maintenance; 
Local dentist fee: 
Midpoint[A]: $125; 
Upper-end[B]: $144; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $115. 

Oral surgery: 

CDT code: D7140; 
Description: Extraction, Erupted Tooth or Exposed Root (Elevation 
and/or Forceps Removal); 
Local dentist fee: 
Midpoint[A]: $153; 
Upper-end[B]: $185; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $145. 

CDT code: D7210; 
Description: Surgical Removal of Erupted Tooth Requiring Removal of 
Bone and/or Sectioning of Tooth, and Including Elevation of the 
Mucoperlosteal Flap if Indicated; 
Local dentist fee: 
Midpoint[A]: $255; 
Upper-end[B]: $300; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $235. 

CDT code: D7240; 
Description: Removal of Impacted Tooth-Completely Bony; 
Local dentist fee: 
Midpoint[A]: $499; 
Upper-end[B]: 499; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $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. 

[End of table] 

Table 20: Dental Fees Charged for Common Procedures in Minneapolis, 
Minnesota (554), 2012: 

Diagnostic: 

CDT code: D0120; 
Description: Periodic Oral Evaluation-Established Patient; 
Local dentist fee: 
Midpoint[A]: $50; 
Upper-end[B]: $60; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $43. 

CDT code: D0150; 
Description: Comprehensive Oral Evaluation-New or Established Patient; 
Local dentist fee: 
Midpoint[A]: $77; 
Upper-end[B]: $99; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $75. 

CDT code: D0220; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical 
First Film; 
Local dentist fee: 
Midpoint[A]: $29; 
Upper-end[B]: $36; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $25. 

CDT code: D0230; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical Each 
Additional Film; 
Local dentist fee: 
Midpoint[A]: $25; 
Upper-end[B]: $34; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $21. 

CDT code: D0274; 
Description: Radiographs/Diagnostic Imaging: Bitewings-Four Films; 
Local dentist fee: 
Midpoint[A]: $60; 
Upper-end[B]: 69; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $56. 

Preventive: 

CDT code: D1110; 
Description: Prophylaxis-Adult; 
Local dentist fee: 
Midpoint[A]: $92; 
Upper-end[B]: $111; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $79. 

CDT code: D1120; 
Description: Prophylaxis-Child; 
Local dentist fee: 
Midpoint[A]: $65; 
Upper-end[B]: $72; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $59. 

CDT code: D1203; 
Description: Topical Application of Fluoride-Child; 
Local dentist fee: 
Midpoint[A]: $42; 
Upper-end[B]: $48; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $32. 

CDT code: D1204; 
Description: Topical Application of Fluoride-Adult; 
Local dentist fee: 
Midpoint[A]: $38; 
Upper-end[B]: $48; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $32. 

CDT code: D1351; 
Description: Sealant-per Tooth; 
Local dentist fee: 
Midpoint[A]: $53; 
Upper-end[B]: $62; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $47. 

Restorative: 

CDT code: D2330; 
Description: Resin-Based Composite-One Surface, Anterior; 
Local dentist fee: 
Midpoint[A]: $155; 
Upper-end[B]: $186; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $140. 

CDT code: D2391; 
Description: Resin-Based Composite-One Surface, Posterior; 
Local dentist fee: 
Midpoint[A]: $170; 
Upper-end[B]: $200; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $153. 

CDT code: D2392; 
Description: Resin-Based Composite-Two Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $244; 
Upper-end[B]: $290; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $200. 

CDT code: D2393; 
Description: Resin-Based Composite-Three Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $300; 
Upper-end[B]: $363; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $249. 

CDT code: D2950; 
Description: Core Buildup, Including Any Pins; 
Local dentist fee: 
Midpoint[A]: $275; 
Upper-end[B]: $340; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $240. 

Endodontics: 

CDT code: D3310; 
Description: Endodontic Therapy, Anterior Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $786; 
Upper-end[B]: $911; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $643. 

CDT code: D3320; 
Description: Endodontic Therapy, Bicuspid Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $917; 
Upper-end[B]: $1,068; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $745. 

CDT code: D3330; 
Description: Endodontic Therapy, Molar (Excluding Final Restoration); 
Local dentist fee: 
Midpoint[A]: $1,122; 
Upper-end[B]: 1,321; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $902. 

Periodontics: 

CDT code: D4341; 
Description: Periodontal Scaling and Root Planing-Four or More Teeth 
per Quadrant; 
Local dentist fee: 
Midpoint[A]: $270; 
Upper-end[B]: $368; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $222. 

CDT code: D4381; 
Description: Localized Delivery of Antimicrobial Agents via a 
Controlled Release Vehicle Into Diseased Crevicular Tissue, per Tooth, 
by Report; 
Local dentist fee: 
Midpoint[A]: $37; 
Upper-end[B]: $60; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $91. 

CDT code: D4910; 
Description: Periodontal Maintenance; 
Local dentist fee: 
Midpoint[A]: $149; 
Upper-end[B]: $182; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $121. 

Oral surgery: 

CDT code: D7140; 
Description: Extraction, Erupted Tooth or Exposed Root (Elevation 
and/or Forceps Removal); 
Local dentist fee: 
Midpoint[A]: $167; 
Upper-end[B]: $200; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $147. 

CDT code: D7210; 
Description: Surgical Removal of Erupted Tooth Requiring Removal of 
Bone and/or Sectioning of Tooth, and Including Elevation of the 
Mucoperlosteal Flap if Indicated; 
Local dentist fee: 
Midpoint[A]: $328; 
Upper-end[B]: $385; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $243. 

CDT code: D7240; 
Description: Removal of Impacted Tooth-Completely Bony; 
Local dentist fee: 
Midpoint[A]: $545; 
Upper-end[B]: $607; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $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. 

[End of table] 

Table 21: Dental Fees Charged for Common Procedures in Mankato, 
Minnesota (560), 2012: 

Diagnostic: 

CDT code: D0120; 
Description: Periodic Oral Evaluation-Established Patient; 
Local dentist fee: 
Midpoint[A]: $41; 
Upper-end[B]: $48; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $35. 

CDT code: D0150; 
Description: Comprehensive Oral Evaluation-New or Established Patient; 
Local dentist fee: 
Midpoint[A]: $63; 
Upper-end[B]: $81; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $63. 

CDT code: D0220; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical 
First Film; 
Local dentist fee: 
Midpoint[A]: $25; 
Upper-end[B]: $33; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $20. 

CDT code: D0230; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical Each 
Additional Film; 
Local dentist fee: 
Midpoint[A]: $23; 
Upper-end[B]: $27; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $20. 

CDT code: D0274; 
Description: Radiographs/Diagnostic Imaging: Bitewings-Four Films; 
Local dentist fee: 
Midpoint[A]: $52; 
Upper-end[B]: 62; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $48. 

Preventive: 

CDT code: D1110; 
Description: Prophylaxis-Adult; 
Local dentist fee: 
Midpoint[A]: $76; 
Upper-end[B]: $89; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $72. 

CDT code: D1120; 
Description: Prophylaxis-Child; 
Local dentist fee: 
Midpoint[A]: $52; 
Upper-end[B]: $62; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $45. 

CDT code: D1203; 
Description: Topical Application of Fluoride-Child; 
Local dentist fee: 
Midpoint[A]: $33; 
Upper-end[B]: $40; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $31. 

CDT code: D1204; 
Description: Topical Application of Fluoride-Adult; 
Local dentist fee: 
Midpoint[A]: $36; 
Upper-end[B]: $40; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $31. 

CDT code: D1351; 
Description: Sealant-per Tooth; 
Local dentist fee: 
Midpoint[A]: $47; 
Upper-end[B]: $50; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $37. 

Restorative: 

CDT code: D2330; 
Description: Resin-Based Composite-One Surface, Anterior; 
Local dentist fee: 
Midpoint[A]: $129; 
Upper-end[B]: $149; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $114. 

CDT code: D2391; 
Description: Resin-Based Composite-One Surface, Posterior; 
Local dentist fee: 
Midpoint[A]: $140; 
Upper-end[B]: $173; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $134. 

CDT code: D2392; 
Description: Resin-Based Composite-Two Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $194; 
Upper-end[B]: $243; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $166. 

CDT code: D2393; 
Description: Resin-Based Composite-Three Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $243; 
Upper-end[B]: $298; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $198. 

CDT code: D2950; 
Description: Core Buildup, Including Any Pins; 
Local dentist fee: 
Midpoint[A]: $217; 
Upper-end[B]: $264; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $201. 

Endodontics: 

CDT code: D3310; 
Description: Endodontic Therapy, Anterior Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $600; 
Upper-end[B]: $787; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $499. 

CDT code: D3320; 
Description: Endodontic Therapy, Bicuspid Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $725; 
Upper-end[B]: $987; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $634. 

CDT code: D3330; 
Description: Endodontic Therapy, Molar (Excluding Final Restoration); 
Local dentist fee: 
Midpoint[A]: $899; 
Upper-end[B]: $1,207; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $768. 

Periodontics: 

CDT code: D4341; 
Description: Periodontal Scaling and Root Planing-Four or More Teeth 
per Quadrant; 
Local dentist fee: 
Midpoint[A]: $239; 
Upper-end[B]: $327; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $256. 

CDT code: D4381; 
Description: Localized Delivery of Antimicrobial Agents via a 
Controlled Release Vehicle Into Diseased Crevicular Tissue, per Tooth, 
by Report; 
Local dentist fee: 
Midpoint[A]: $39; 
Upper-end[B]: $48; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $64. 

CDT code: D4910; 
Description: Periodontal Maintenance; 
Local dentist fee: 
Midpoint[A]: $128; 
Upper-end[B]: $145; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $114. 

Oral surgery: 

CDT code: D7140; 
Description: Extraction, Erupted Tooth or Exposed Root (Elevation 
and/or Forceps Removal); 
Local dentist fee: 
Midpoint[A]: $132; 
Upper-end[B]: $175; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $122. 

CDT code: D7210; 
Description: Surgical Removal of Erupted Tooth Requiring Removal of 
Bone and/or Sectioning of Tooth, and Including Elevation of the 
Mucoperlosteal Flap if Indicated; 
Local dentist fee: 
Midpoint[A]: $242; 
Upper-end[B]: $273; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $193. 

CDT code: D7240; 
Description: Removal of Impacted Tooth-Completely Bony; 
Local dentist fee: 
Midpoint[A]: $469; 
Upper-end[B]: $486; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $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. 

[End of table] 

Table 22: Dental Fees Charged for Common Procedures in New York, New 
York (100), 2012: 

Diagnostic: 

CDT code: D0120; 
Description: Periodic Oral Evaluation-Established Patient; 
Local dentist fee: 
Midpoint[A]: $80; 
Upper-end[B]: $152; 
Health center fee: 
100% FPL[C]: $23; 
Full fee[D]: $68. 

CDT code: D0150; 
Description: Comprehensive Oral Evaluation-New or Established Patient; 
Local dentist fee: 
Midpoint[A]: $123; 
Upper-end[B]: $200; 
Health center fee: 
100% FPL[C]: $46; 
Full fee[D]: $220. 

CDT code: D0220; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical 
First Film; 
Local dentist fee: 
Midpoint[A]: $29; 
Upper-end[B]: $50; 
Health center fee: 
100% FPL[C]: $11; 
Full fee[D]: $36. 

CDT code: D0230; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical Each 
Additional Film; 
Local dentist fee: 
Midpoint[A]: $21; 
Upper-end[B]: $50; 
Health center fee: 
100% FPL[C]: $6; 
Full fee[D]: $30. 

CDT code: D0274; 
Description: Radiographs/Diagnostic Imaging: Bitewings-Four Films; 
Local dentist fee: 
Midpoint[A]: $80; 
Upper-end[B]: 140; 
Health center fee: 
100% FPL[C]: $23; 
Full fee[D]: $80. 

Preventive: 

CDT code: D1110; 
Description: Prophylaxis-Adult; 
Local dentist fee: 
Midpoint[A]: $155; 
Upper-end[B]: $215; 
Health center fee: 
100% FPL[C]: $46; 
Full fee[D]: $117. 

CDT code: D1120; 
Description: Prophylaxis-Child; 
Local dentist fee: 
Midpoint[A]: $105; 
Upper-end[B]: $160; 
Health center fee: 
100% FPL[C]: $34; 
Full fee[D]: $85. 

CDT code: D1203; 
Description: Topical Application of Fluoride-Child; 
Local dentist fee: 
Midpoint[A]: $55; 
Upper-end[B]: $100; 
Health center fee: 
100% FPL[C]: $11; 
Full fee[D]: $47. 

CDT code: D1204; 
Description: Topical Application of Fluoride-Adult; 
Local dentist fee: 
Midpoint[A]: $70; 
Upper-end[B]: $125; 
Health center fee: 
100% FPL[C]: $11; 
Full fee[D]: $51. 

CDT code: D1351; 
Description: Sealant-per Tooth; 
Local dentist fee: 
Midpoint[A]: $90; 
Upper-end[B]: $125; 
Health center fee: 
100% FPL[C]: $34; 
Full fee[D]: $68. 

Restorative: 

CDT code: D2330; 
Description: Resin-Based Composite-One Surface, Anterior; 
Local dentist fee: 
Midpoint[A]: $225; 
Upper-end[B]: $400; 
Health center fee: 
100% FPL[C]: $46; 
Full fee[D]: $198. 

CDT code: D2391; 
Description: Resin-Based Composite-One Surface, Posterior; 
Local dentist fee: 
Midpoint[A]: $247; 
Upper-end[B]: $375; 
Health center fee: 
100% FPL[C]: $44; 
Full fee[D]: $229. 

CDT code: D2392; 
Description: Resin-Based Composite-Two Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $300; 
Upper-end[B]: $450; 
Health center fee: 
100% FPL[C]: $67; 
Full fee[D]: $292. 

CDT code: D2393; 
Description: Resin-Based Composite-Three Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $350; 
Upper-end[B]: $500; 
Health center fee: 
100% FPL[C]: $85; 
Full fee[D]: $365. 

CDT code: D2950; 
Description: Core Buildup, Including Any Pins; 
Local dentist fee: 
Midpoint[A]: $350; 
Upper-end[B]: $600; 
Health center fee: 
100% FPL[C]: $75; 
Full fee[D]: $355. 

Endodontics: 

CDT code: D3310; 
Description: Endodontic Therapy, Anterior Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $1,000; 
Upper-end[B]: $1,900; 
Health center fee: 
100% FPL[C]: $200; 
Full fee[D]: $891. 

CDT code: D3320; 
Description: Endodontic Therapy, Bicuspid Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $1,150; 
Upper-end[B]: $1,950; 
Health center fee: 
100% FPL[C]: $240; 
Full fee[D]: $1,038. 

CDT code: D3330; 
Description: Endodontic Therapy, Molar (Excluding Final Restoration); 
Local dentist fee: 
Midpoint[A]: $1,400; 
Upper-end[B]: 2,200; 
Health center fee: 
100% FPL[C]: $325; 
Full fee[D]: $1,236. 

Periodontics: 

CDT code: D4341; 
Description: Periodontal Scaling and Root Planing-Four or More Teeth 
per Quadrant; 
Local dentist fee: 
Midpoint[A]: $250; 
Upper-end[B]: $420; 
Health center fee: 
100% FPL[C]: $46; 
Full fee[D]: $320. 

CDT code: D4381; 
Description: Localized Delivery of Antimicrobial Agents via a 
Controlled Release Vehicle Into Diseased Crevicular Tissue, per Tooth, 
by Report; 
Local dentist fee: 
Midpoint[A]: $75; 
Upper-end[B]: $180; 
Health center fee: 
100% FPL[C]: $130; 
Full fee[D]: $247. 

CDT code: D4910; 
Description: Periodontal Maintenance; 
Local dentist fee: 
Midpoint[A]: $195; 
Upper-end[B]: $295; 
Health center fee: 
100% FPL[C]: $46; 
Full fee[D]: $179. 

Oral surgery: 

CDT code: D7140; 
Description: Extraction, Erupted Tooth or Exposed Root (Elevation 
and/or Forceps Removal); 
Local dentist fee: 
Midpoint[A]: $290; 
Upper-end[B]: $600; 
Health center fee: 
100% FPL[C]: $36; 
Full fee[D]: $229. 

CDT code: D7210; 
Description: Surgical Removal of Erupted Tooth Requiring Removal of 
Bone and/or Sectioning of Tooth, and Including Elevation of the 
Mucoperlosteal Flap if Indicated; 
Local dentist fee: 
Midpoint[A]: $400; 
Upper-end[B]: $750; 
Health center fee: 
100% FPL[C]: $72; 
Full fee[D]: $357. 

CDT code: D7240; 
Description: Removal of Impacted Tooth-Completely Bony; 
Local dentist fee: 
Midpoint[A]: $650; 
Upper-end[B]: $1,050; 
Health center fee: 
100% FPL[C]: $240; 
Full fee[D]: $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. 

[End of table] 

Table 23: Dental Fees Charged for Common Procedures in Elmira, New 
York (148), 2012: 

Diagnostic: 

CDT code: D0120; 
Description: Periodic Oral Evaluation-Established Patient; 
Local dentist fee: 
Midpoint[A]: $40; 
Upper-end[B]: $52; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $28. 

CDT code: D0150; 
Description: Comprehensive Oral Evaluation-New or Established Patient; 
Local dentist fee: 
Midpoint[A]: $68; 
Upper-end[B]: $106; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $48. 

CDT code: D0220; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical 
First Film; 
Local dentist fee: 
Midpoint[A]: $25; 
Upper-end[B]: $33; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $18. 

CDT code: D0230; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical Each 
Additional Film; 
Local dentist fee: 
Midpoint[A]: $14; 
Upper-end[B]: $26; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $15. 

CDT code: D0274; 
Description: Radiographs/Diagnostic Imaging: Bitewings-Four Films; 
Local dentist fee: 
Midpoint[A]: $57; 
Upper-end[B]: 77; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $59. 

Preventive: 

CDT code: D1110; 
Description: Prophylaxis-Adult; 
Local dentist fee: 
Midpoint[A]: $77; 
Upper-end[B]: $95; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $69. 

CDT code: D1120; 
Description: Prophylaxis-Child; 
Local dentist fee: 
Midpoint[A]: $54; 
Upper-end[B]: $70; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $52. 

CDT code: D1203; 
Description: Topical Application of Fluoride-Child; 
Local dentist fee: 
Midpoint[A]: $30; 
Upper-end[B]: $35; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $21. 

CDT code: D1204; 
Description: Topical Application of Fluoride-Adult; 
Local dentist fee: 
Midpoint[A]: $30; 
Upper-end[B]: $40; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $30. 

CDT code: D1351; 
Description: Sealant-per Tooth; 
Local dentist fee: 
Midpoint[A]: $50; 
Upper-end[B]: $54; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $35. 

Restorative: 

CDT code: D2330; 
Description: Resin-Based Composite-One Surface, Anterior; 
Local dentist fee: 
Midpoint[A]: $129; 
Upper-end[B]: $161; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $92. 

CDT code: D2391; 
Description: Resin-Based Composite-One Surface, Posterior; 
Local dentist fee: 
Midpoint[A]: $145; 
Upper-end[B]: $181; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $132. 

CDT code: D2392; 
Description: Resin-Based Composite-Two Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $179; 
Upper-end[B]: $230; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $166. 

CDT code: D2393; 
Description: Resin-Based Composite-Three Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $220; 
Upper-end[B]: $315; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $193. 

CDT code: D2950; 
Description: Core Buildup, Including Any Pins; 
Local dentist fee: 
Midpoint[A]: $250; 
Upper-end[B]: $350; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $125. 

Endodontics: 

CDT code: D3310; 
Description: Endodontic Therapy, Anterior Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $650; 
Upper-end[B]: $950; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $559. 

CDT code: D3320; 
Description: Endodontic Therapy, Bicuspid Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $751; 
Upper-end[B]: $1,050; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $850. 

CDT code: D3330; 
Description: Endodontic Therapy, Molar (Excluding Final Restoration); 
Local dentist fee: 
Midpoint[A]: $1,000; 
Upper-end[B]: 1,150; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $1,044. 

Periodontics: 

CDT code: D4341; 
Description: Periodontal Scaling and Root Planing-Four or More Teeth 
per Quadrant; 
Local dentist fee: 
Midpoint[A]: $224; 
Upper-end[B]: $260; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $137. 

CDT code: D4381; 
Description: Localized Delivery of Antimicrobial Agents via a 
Controlled Release Vehicle Into Diseased Crevicular Tissue, per Tooth, 
by Report; 
Local dentist fee: 
Midpoint[A]: $75; 
Upper-end[B]: $81; 
Health center fee: 
100% FPL[C]: $e; 
Full fee[D]: $e. 

CDT code: D4910; 
Description: Periodontal Maintenance; 
Local dentist fee: 
Midpoint[A]: $90; 
Upper-end[B]: $138; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $104. 

Oral surgery: 

CDT code: D7140; 
Description: Extraction, Erupted Tooth or Exposed Root (Elevation 
and/or Forceps Removal); 
Local dentist fee: 
Midpoint[A]: $143; 
Upper-end[B]: $180; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $122. 

CDT code: D7210; 
Description: Surgical Removal of Erupted Tooth Requiring Removal of 
Bone and/or Sectioning of Tooth, and Including Elevation of the 
Mucoperlosteal Flap if Indicated; 
Local dentist fee: 
Midpoint[A]: $265; 
Upper-end[B]: $325; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $214. 

CDT code: D7240; 
Description: Removal of Impacted Tooth-Completely Bony; 
Local dentist fee: 
Midpoint[A]: $460; 
Upper-end[B]: $546; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $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] 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 provide or bill separately for this 
procedure. 

[End of table] 

Table 24: Dental Fees Charged for Common Procedures in Nashville, 
Tennessee (372), 2012: 

Diagnostic: 

CDT code: D0120; 
Description: Periodic Oral Evaluation-Established Patient; 
Local dentist fee: 
Midpoint[A]: $42; 
Upper-end[B]: $57; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $35. 

CDT code: D0150; 
Description: Comprehensive Oral Evaluation-New or Established Patient; 
Local dentist fee: 
Midpoint[A]: $74; 
Upper-end[B]: $105; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $45. 

CDT code: D0220; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical 
First Film; 
Local dentist fee: 
Midpoint[A]: $26; 
Upper-end[B]: $39; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $15. 

CDT code: D0230; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical Each 
Additional Film; 
Local dentist fee: 
Midpoint[A]: $22; 
Upper-end[B]: $35; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $12. 

CDT code: D0274; 
Description: Radiographs/Diagnostic Imaging: Bitewings-Four Films; 
Local dentist fee: 
Midpoint[A]: $57; 
Upper-end[B]: 75; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $34. 

Preventive: 

CDT code: D1110; 
Description: Prophylaxis-Adult; 
Local dentist fee: 
Midpoint[A]: $76; 
Upper-end[B]: $98; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $45. 

CDT code: D1120; 
Description: Prophylaxis-Child; 
Local dentist fee: 
Midpoint[A]: $55; 
Upper-end[B]: $75; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $50. 

CDT code: D1203; 
Description: Topical Application of Fluoride-Child; 
Local dentist fee: 
Midpoint[A]: $29; 
Upper-end[B]: $40; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $21. 

CDT code: D1204; 
Description: Topical Application of Fluoride-Adult; 
Local dentist fee: 
Midpoint[A]: $26; 
Upper-end[B]: $41; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $20. 

CDT code: D1351; 
Description: Sealant-per Tooth; 
Local dentist fee: 
Midpoint[A]: $42; 
Upper-end[B]: $60; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $35. 

Restorative: 

CDT code: D2330; 
Description: Resin-Based Composite-One Surface, Anterior; 
Local dentist fee: 
Midpoint[A]: $140; 
Upper-end[B]: $176; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $75. 

CDT code: D2391; 
Description: Resin-Based Composite-One Surface, Posterior; 
Local dentist fee: 
Midpoint[A]: $155; 
Upper-end[B]: $196; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $125. 

CDT code: D2392; 
Description: Resin-Based Composite-Two Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $200; 
Upper-end[B]: $287; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $150. 

CDT code: D2393; 
Description: Resin-Based Composite-Three Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $245; 
Upper-end[B]: $350; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $160. 

CDT code: D2950; 
Description: Core Buildup, Including Any Pins; 
Local dentist fee: 
Midpoint[A]: $242; 
Upper-end[B]: $310; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $250. 

Endodontics: 

CDT code: D3310; 
Description: Endodontic Therapy, Anterior Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $794; 
Upper-end[B]: $1,175; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $355. 

CDT code: D3320; 
Description: Endodontic Therapy, Bicuspid Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $991; 
Upper-end[B]: $1,275; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $425. 

CDT code: D3330; 
Description: Endodontic Therapy, Molar (Excluding Final Restoration); 
Local dentist fee: 
Midpoint[A]: $1,136; 
Upper-end[B]: 1,395; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $519. 

Periodontics: 

CDT code: D4341; 
Description: Periodontal Scaling and Root Planing-Four or More Teeth 
per Quadrant; 
Local dentist fee: 
Midpoint[A]: $215; 
Upper-end[B]: $266; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $600. 

CDT code: D4381; 
Description: Localized Delivery of Antimicrobial Agents via a 
Controlled Release Vehicle Into Diseased Crevicular Tissue, per Tooth, 
by Report; 
Local dentist fee: 
Midpoint[A]: $37; 
Upper-end[B]: $43; 
Health center fee: 
100% FPL[C]: [E]; 
Full fee[D]: [E]. 

CDT code: D4910; 
Description: Periodontal Maintenance; 
Local dentist fee: 
Midpoint[A]: $122; 
Upper-end[B]: $150; 
Health center fee: 
100% FPL[C]: [E]; 
Full fee[D]: [E]. 

Oral surgery: 

CDT code: D7140; 
Description: Extraction, Erupted Tooth or Exposed Root (Elevation 
and/or Forceps Removal); 
Local dentist fee: 
Midpoint[A]: $125; 
Upper-end[B]: $201; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $70. 

CDT code: D7210; 
Description: Surgical Removal of Erupted Tooth Requiring Removal of 
Bone and/or Sectioning of Tooth, and Including Elevation of the 
Mucoperlosteal Flap if Indicated; 
Local dentist fee: 
Midpoint[A]: $245; 
Upper-end[B]: $319; 
Health center fee: 
100% FPL[C]: $0; 
Full fee[D]: $133. 

CDT code: D7240; 
Description: Removal of Impacted Tooth-Completely Bony; 
Local dentist fee: 
Midpoint[A]: $447; 
Upper-end[B]: $475; 
Health center fee: 
100% FPL[C]: [E]; 
Full fee[D]: [E]. 

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. 

[E] Health center does not provide or bill separately for this 
procedure. 

[End of table] 

Table 25: Dental Fees Charged for Common Procedures in Jackson, 
Tennessee (382), 2012: 

Diagnostic: 

CDT code: D0120; 
Description: Periodic Oral Evaluation-Established Patient; 
Local dentist fee: 
Midpoint[A]: $33; 
Upper-end[B]: $45; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: [D]. 

CDT code: D0150; 
Description: Comprehensive Oral Evaluation-New or Established Patient; 
Local dentist fee: 
Midpoint[A]: $53; 
Upper-end[B]: $71; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: [D]. 

CDT code: D0220; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical 
First Film; 
Local dentist fee: 
Midpoint[A]: $20; 
Upper-end[B]: $28; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: [D]. 

CDT code: D0230; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical Each 
Additional Film; 
Local dentist fee: 
Midpoint[A]: $18; 
Upper-end[B]: $25; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: [D]. 

CDT code: D0274; 
Description: Radiographs/Diagnostic Imaging: Bitewings-Four Films; 
Local dentist fee: 
Midpoint[A]: $50; 
Upper-end[B]: 62; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: [D]. 

Preventive: 

CDT code: D1110; 
Description: Prophylaxis-Adult; 
Local dentist fee: 
Midpoint[A]: $59; 
Upper-end[B]: $71; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: [D]. 

CDT code: D1120; 
Description: Prophylaxis-Child; 
Local dentist fee: 
Midpoint[A]: $48; 
Upper-end[B]: $55; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: [D]. 

CDT code: D1203; 
Description: Topical Application of Fluoride-Child; 
Local dentist fee: 
Midpoint[A]: $24; 
Upper-end[B]: $30; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: [D]. 

CDT code: D1204; 
Description: Topical Application of Fluoride-Adult; 
Local dentist fee: 
Midpoint[A]: $24; 
Upper-end[B]: $30; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: [D]. 

CDT code: D1351; 
Description: Sealant-per Tooth; 
Local dentist fee: 
Midpoint[A]: $43; 
Upper-end[B]: $48; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: [D]. 

Restorative: 

CDT code: D2330; 
Description: Resin-Based Composite-One Surface, Anterior; 
Local dentist fee: 
Midpoint[A]: $102; 
Upper-end[B]: $137; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: [D]. 

CDT code: D2391; 
Description: Resin-Based Composite-One Surface, Posterior; 
Local dentist fee: 
Midpoint[A]: $125; 
Upper-end[B]: $150; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: [D]. 

CDT code: D2392; 
Description: Resin-Based Composite-Two Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $160; 
Upper-end[B]: $191; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: [D]. 

CDT code: D2393; 
Description: Resin-Based Composite-Three Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $190; 
Upper-end[B]: $245; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: [D]. 

CDT code: D2950; 
Description: Core Buildup, Including Any Pins; 
Local dentist fee: 
Midpoint[A]: $175; 
Upper-end[B]: $213; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: [D]. 

Endodontics: 

CDT code: D3310; 
Description: Endodontic Therapy, Anterior Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $567; 
Upper-end[B]: $700; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: [D]. 

CDT code: D3320; 
Description: Endodontic Therapy, Bicuspid Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $635; 
Upper-end[B]: $840; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: [D]. 

CDT code: D3330; 
Description: Endodontic Therapy, Molar (Excluding Final Restoration); 
Local dentist fee: 
Midpoint[A]: $801; 
Upper-end[B]: $1,044; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: [D]. 

Periodontics: 

CDT code: D4341; 
Description: Periodontal Scaling and Root Planing-Four or More Teeth 
per Quadrant; 
Local dentist fee: 
Midpoint[A]: $175; 
Upper-end[B]: $211; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: [D]. 

CDT code: D4381; 
Description: Localized Delivery of Antimicrobial Agents via a 
Controlled Release Vehicle Into Diseased Crevicular Tissue, per Tooth, 
by Report; 
Local dentist fee: 
Midpoint[A]: $58; 
Upper-end[B]: Insufficient data; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: [D]. 

CDT code: D4910; 
Description: Periodontal Maintenance; 
Local dentist fee: 
Midpoint[A]: $98; 
Upper-end[B]: $127; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: [D]. 

Oral surgery: 

CDT code: D7140; 
Description: Extraction, Erupted Tooth or Exposed Root (Elevation 
and/or Forceps Removal); 
Local dentist fee: 
Midpoint[A]: $97; 
Upper-end[B]: $138; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: [D]. 

CDT code: D7210; 
Description: Surgical Removal of Erupted Tooth Requiring Removal of 
Bone and/or Sectioning of Tooth, and Including Elevation of the 
Mucoperlosteal Flap if Indicated; 
Local dentist fee: 
Midpoint[A]: $200; 
Upper-end[B]: $250; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: [D]. 

CDT code: D7240; 
Description: Removal of Impacted Tooth-Completely Bony; 
Local dentist fee: 
Midpoint[A]: $365; 
Upper-end[B]: $425; 
Health center fee: 
100% FPL[C]: [C]; 
Full fee[D]: [D]. 

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 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. 

[End of table] 

Table 26: Dental Fees Charged for Common Procedures in Dallas, Texas 
(752), 2012: 

Diagnostic: 

CDT code: D0120; 
Description: Periodic Oral Evaluation-Established Patient; 
Local dentist fee: 
Midpoint[A]: $47; 
Upper-end[B]: $61; 
Health center fee: 
100% FPL[C]: $4.6; 
Full fee[D]: $46. 

CDT code: D0150; 
Description: Comprehensive Oral Evaluation-New or Established Patient; 
Local dentist fee: 
Midpoint[A]: $78; 
Upper-end[B]: $107; 
Health center fee: 
100% FPL[C]: $8; 
Full fee[D]: $80. 

CDT code: D0220; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical 
First Film; 
Local dentist fee: 
Midpoint[A]: $23; 
Upper-end[B]: $34; 
Health center fee: 
100% FPL[C]: $2.7; 
Full fee[D]: $27. 

CDT code: D0230; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical Each 
Additional Film; 
Local dentist fee: 
Midpoint[A]: $17; 
Upper-end[B]: $26; 
Health center fee: 
100% FPL[C]: $2.2; 
Full fee[D]: $22. 

CDT code: D0274; 
Description: Radiographs/Diagnostic Imaging: Bitewings-Four Films; 
Local dentist fee: 
Midpoint[A]: $59; 
Upper-end[B]: 79; 
Health center fee: 
100% FPL[C]: $6; 
Full fee[D]: $60. 

Preventive: 

CDT code: D1110; 
Description: Prophylaxis-Adult; 
Local dentist fee: 
Midpoint[A]: $89; 
Upper-end[B]: $110; 
Health center fee: 
100% FPL[C]: $8.5; 
Full fee[D]: $85. 

CDT code: D1120; 
Description: Prophylaxis-Child; 
Local dentist fee: 
Midpoint[A]: $63; 
Upper-end[B]: $78; 
Health center fee: 
100% FPL[C]: $6.4; 
Full fee[D]: $64. 

CDT code: D1203; 
Description: Topical Application of Fluoride-Child; 
Local dentist fee: 
Midpoint[A]: $32; 
Upper-end[B]: $38; 
Health center fee: 
100% FPL[C]: $3.5; 
Full fee[D]: $35. 

CDT code: D1204; 
Description: Topical Application of Fluoride-Adult; 
Local dentist fee: 
Midpoint[A]: $31; 
Upper-end[B]: $39; 
Health center fee: 
100% FPL[C]: [E]; 
Full fee[D]: [E]. 

CDT code: D1351; 
Description: Sealant-per Tooth; 
Local dentist fee: 
Midpoint[A]: $50; 
Upper-end[B]: $65; 
Health center fee: 
100% FPL[C]: $5; 
Full fee[D]: $50. 

Restorative: 

CDT code: D2330; 
Description: Resin-Based Composite-One Surface, Anterior; 
Local dentist fee: 
Midpoint[A]: $154; 
Upper-end[B]: $220; 
Health center fee: 
100% FPL[C]: $15; 
Full fee[D]: $150. 

CDT code: D2391; 
Description: Resin-Based Composite-One Surface, Posterior; 
Local dentist fee: 
Midpoint[A]: $146; 
Upper-end[B]: $218; 
Health center fee: 
100% FPL[C]: $16.7; 
Full fee[D]: $167. 

CDT code: D2392; 
Description: Resin-Based Composite-Two Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $189; 
Upper-end[B]: $294; 
Health center fee: 
100% FPL[C]: $21.7; 
Full fee[D]: $217. 

CDT code: D2393; 
Description: Resin-Based Composite-Three Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $261; 
Upper-end[B]: $344; 
Health center fee: 
100% FPL[C]: $26.8; 
Full fee[D]: $268. 

CDT code: D2950; 
Description: Core Buildup, Including Any Pins; 
Local dentist fee: 
Midpoint[A]: $243; 
Upper-end[B]: $313; 
Health center fee: 
100% FPL[C]: [E]; 
Full fee[D]: [E]. 

Endodontics: 

CDT code: D3310; 
Description: Endodontic Therapy, Anterior Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $695; 
Upper-end[B]: $1,250; 
Health center fee: 
100% FPL[C]: $69.4; 
Full fee[D]: $694. 

CDT code: D3320; 
Description: Endodontic Therapy, Bicuspid Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $815; 
Upper-end[B]: $1,327; 
Health center fee: 
100% FPL[C]: $80; 
Full fee[D]: $800. 

CDT code: D3330; 
Description: Endodontic Therapy, Molar (Excluding Final Restoration); 
Local dentist fee: 
Midpoint[A]: $1,025; 
Upper-end[B]: 1,677; 
Health center fee: 
100% FPL[C]: $60; 
Full fee[D]: $600. 

Periodontics: 

CDT code: D4341; 
Description: Periodontal Scaling and Root Planing-Four or More Teeth 
per Quadrant; 
Local dentist fee: 
Midpoint[A]: $245; 
Upper-end[B]: $301; 
Health center fee: 
100% FPL[C]: $24.1; 
Full fee[D]: $241. 

CDT code: D4381; 
Description: Localized Delivery of Antimicrobial Agents via a 
Controlled Release Vehicle Into Diseased Crevicular Tissue, per Tooth, 
by Report; 
Local dentist fee: 
Midpoint[A]: $60; 
Upper-end[B]: $91; 
Health center fee: 
100% FPL[C]: [E]; 
Full fee[D]: [E]. 

CDT code: D4910; 
Description: Periodontal Maintenance; 
Local dentist fee: 
Midpoint[A]: $130; 
Upper-end[B]: $166; 
Health center fee: 
100% FPL[C]: [E]; 
Full fee[D]: [E]. 

Oral surgery: 

CDT code: D7140; 
Description: Extraction, Erupted Tooth or Exposed Root (Elevation 
and/or Forceps Removal); 
Local dentist fee: 
Midpoint[A]: $152; 
Upper-end[B]: $245; 
Health center fee: 
100% FPL[C]: $15.9; 
Full fee[D]: $159. 

CDT code: D7210; 
Description: Surgical Removal of Erupted Tooth Requiring Removal of 
Bone and/or Sectioning of Tooth, and Including Elevation of the 
Mucoperlosteal Flap if Indicated; 
Local dentist fee: 
Midpoint[A]: $265; 
Upper-end[B]: $355; 
Health center fee: 
100% FPL[C]: $25.7; 
Full fee[D]: $257. 

CDT code: D7240; 
Description: Removal of Impacted Tooth-Completely Bony; 
Local dentist fee: 
Midpoint[A]: $463; 
Upper-end[B]: $564; 
Health center fee: 
100% FPL[C]: [E]; 
Full fee[D]: [E]. 

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 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. 

[End of table] 

Table 27: Dental Fees Charged for Common Procedures in San Angelo, 
Texas (768), 2012: 

Diagnostic: 

CDT code: D0120; 
Description: Periodic Oral Evaluation-Established Patient; 
Local dentist fee: 
Midpoint[A]: $38; 
Upper-end[B]: $60; 
Health center fee: 
100% FPL[C]: $15; 
Full fee[D]: $74. 

CDT code: D0150; 
Description: Comprehensive Oral Evaluation-New or Established Patient; 
Local dentist fee: 
Midpoint[A]: $65; 
Upper-end[B]: $91; 
Health center fee: 
100% FPL[C]: $18; 
Full fee[D]: $90. 

CDT code: D0220; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical 
First Film; 
Local dentist fee: 
Midpoint[A]: $22; 
Upper-end[B]: $30; 
Health center fee: 
100% FPL[C]: $6; 
Full fee[D]: $32. 

CDT code: D0230; 
Description: Radiographs/Diagnostic Imaging: Intraoral-Periapical Each 
Additional Film; 
Local dentist fee: 
Midpoint[A]: $18; 
Upper-end[B]: $25; 
Health center fee: 
100% FPL[C]: $6; 
Full fee[D]: $29. 

CDT code: D0274; 
Description: Radiographs/Diagnostic Imaging: Bitewings-Four Films; 
Local dentist fee: 
Midpoint[A]: $51; 
Upper-end[B]: 65; 
Health center fee: 
100% FPL[C]: $14; 
Full fee[D]: $68. 

Preventive: 

CDT code: D1110; 
Description: Prophylaxis-Adult; 
Local dentist fee: 
Midpoint[A]: $75; 
Upper-end[B]: $96; 
Health center fee: 
100% FPL[C]: $21; 
Full fee[D]: $105. 

CDT code: D1120; 
Description: Prophylaxis-Child; 
Local dentist fee: 
Midpoint[A]: $55; 
Upper-end[B]: $72; 
Health center fee: 
100% FPL[C]: $17; 
Full fee[D]: $85. 

CDT code: D1203; 
Description: Topical Application of Fluoride-Child; 
Local dentist fee: 
Midpoint[A]: $30; 
Upper-end[B]: $40; 
Health center fee: 
100% FPL[C]: $8; 
Full fee[D]: $38. 

CDT code: D1204; 
Description: Topical Application of Fluoride-Adult; 
Local dentist fee: 
Midpoint[A]: $25; 
Upper-end[B]: $40; 
Health center fee: 
100% FPL[C]: $8; 
Full fee[D]: $38. 

CDT code: D1351; 
Description: Sealant-per Tooth; 
Local dentist fee: 
Midpoint[A]: $48; 
Upper-end[B]: $60; 
Health center fee: 
100% FPL[C]: $9; 
Full fee[D]: $47. 

Restorative: 

CDT code: D2330; 
Description: Resin-Based Composite-One Surface, Anterior; 
Local dentist fee: 
Midpoint[A]: $126; 
Upper-end[B]: $180; 
Health center fee: 
100% FPL[C]: $28; 
Full fee[D]: $140. 

CDT code: D2391; 
Description: Resin-Based Composite-One Surface, Posterior; 
Local dentist fee: 
Midpoint[A]: $139; 
Upper-end[B]: $193; 
Health center fee: 
100% FPL[C]: $31; 
Full fee[D]: $155. 

CDT code: D2392; 
Description: Resin-Based Composite-Two Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $180; 
Upper-end[B]: $242; 
Health center fee: 
100% FPL[C]: $40; 
Full fee[D]: $200. 

CDT code: D2393; 
Description: Resin-Based Composite-Three Surfaces, Posterior; 
Local dentist fee: 
Midpoint[A]: $228; 
Upper-end[B]: $300; 
Health center fee: 
100% FPL[C]: $48; 
Full fee[D]: $240. 

CDT code: D2950; 
Description: Core Buildup, Including Any Pins; 
Local dentist fee: 
Midpoint[A]: $225; 
Upper-end[B]: $300; 
Health center fee: 
100% FPL[C]: $23; 
Full fee[D]: $113. 

Endodontics: 

CDT code: D3310; 
Description: Endodontic Therapy, Anterior Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $645; 
Upper-end[B]: $850; 
Health center fee: 
100% FPL[C]: $490[E]; 
Full fee[D]: $490. 

CDT code: D3320; 
Description: Endodontic Therapy, Bicuspid Tooth (Excluding Final 
Restoration); 
Local dentist fee: 
Midpoint[A]: $715; 
Upper-end[B]: $950; 
Health center fee: 
100% FPL[C]: $580[E]; 
Full fee[D]: $580. 

CDT code: D3330; 
Description: Endodontic Therapy, Molar (Excluding Final Restoration); 
Local dentist fee: 
Midpoint[A]: $948; 
Upper-end[B]: $1,150; 
Health center fee: 
100% FPL[C]: [F]; 
Full fee[D]: [F]. 

Periodontics: 

CDT code: D4341; 
Description: Periodontal Scaling and Root Planing-Four or More Teeth 
per Quadrant; 
Local dentist fee: 
Midpoint[A]: $204; 
Upper-end[B]: $275; 
Health center fee: 
100% FPL[C]: $100[E]; 
Full fee[D]: $100. 

CDT code: D4381; 
Description: Localized Delivery of Antimicrobial Agents via a 
Controlled Release Vehicle Into Diseased Crevicular Tissue, per Tooth, 
by Report; 
Local dentist fee: 
Midpoint[A]: $63; 
Upper-end[B]: $80; 
Health center fee: 
100% FPL[C]: [F]; 
Full fee[D]: [F]. 

CDT code: D4910; 
Description: Periodontal Maintenance; 
Local dentist fee: 
Midpoint[A]: $112; 
Upper-end[B]: $158; 
Health center fee: 
100% FPL[C]: $120[E]; 
Full fee[D]: $120. 

Oral surgery: 

CDT code: D7140; 
Description: Extraction, Erupted Tooth or Exposed Root (Elevation 
and/or Forceps Removal); 
Local dentist fee: 
Midpoint[A]: $137; 
Upper-end[B]: $187; 
Health center fee: 
100% FPL[C]: $148[E]; 
Full fee[D]: $148. 

CDT code: D7210; 
Description: Surgical Removal of Erupted Tooth Requiring Removal of 
Bone and/or Sectioning of Tooth, and Including Elevation of the 
Mucoperlosteal Flap if Indicated; 
Local dentist fee: 
Midpoint[A]: $227; 
Upper-end[B]: $322; 
Health center fee: 
100% FPL[C]: $257[E]; 
Full fee[D]: $257. 

CDT code: D7240; 
Description: Removal of Impacted Tooth-Completely Bony; 
Local dentist fee: 
Midpoint[A]: $390; 
Upper-end[B]: $390; 
Health center fee: 
100% FPL[C]: [F]; 
Full fee[D]: [F]. 

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. 

[E] Health center does not discount this service. 

[F] Health center does not provide or bill separately for this 
procedure. 

[End of table] 

[End of section] 

Appendix V: GAO Contact and Staff Acknowledgments: 

GAO Contact: 

Katherine Iritani, (202) 512-7114, or iritanik@gao.gov: 

Staff Acknowledgments: 

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. 

[End of section] 

Related GAO Products: 

Oral Health: Efforts Under Way to Improve Children's Access to Dental 
Services, but Sustained Attention Needed to Address Ongoing Concerns. 
[hyperlink, http://www.gao.gov/products/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. 
[hyperlink, http://www.gao.gov/products/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. [hyperlink, 
http://www.gao.gov/products/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. [hyperlink, 
http://www.gao.gov/products/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. [hyperlink, http://www.gao.gov/products/GAO-08-723]. 
Washington, D.C.: August 8, 2008. 

Medicaid: Concerns Remain about Sufficiency of Data for Oversight of 
Children's Dental Services. [hyperlink, 
http://www.gao.gov/products/GAO-07-826T]. Washington, D.C.: May 2, 
2007. 

Oral Health: Factors Contributing to Low Use of Dental Services by Low-
Income Populations. [hyperlink, 
http://www.gao.gov/products/GAO/HEHS-00-149]. Washington, D.C.: 
September 11, 2000. 

Oral Health: Dental Disease Is a Chronic Problem Among Low-Income 
Populations. [hyperlink, http://www.gao.gov/products/GAO/HEHS-00-72]. 
Washington, D.C.: April 12, 2000. 

[End of section] 

Footnotes: 

[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. 

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

[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 [hyperlink, 
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. 

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

[10] FAIR 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 [hyperlink, 
http://www.fairhealth.org/] for more information about FAIR Health, 
Inc., and its dental claims data set. 

[11] FAIR 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). 

[12] Codes on Dental Procedure and Nomenclature are the intellectual 
property of the ADA as copyright owner. 

[13] The 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. 

[14] 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. 

[15] Bureau of Labor Statistics, Selected Medical Benefits: A Report 
from the Department of Labor to the Department of Health and Human 
Services (Washington, D.C.: April 15, 2011). This survey was 
conducted by the Bureau of Labor Statistics of employer-sponsored 
health plans to determine the benefits typically covered by employers. 

[16] 42 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. 

[17] The 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. 

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

[19] Private 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. 

[20] For 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. 

[21] Most of these individuals reported having Medicare coverage. 
Traditional Medicare offers very limited dental benefits. Medicare 
Advantage plans may includes 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. 

[22] For this analysis, poor individuals are individuals in families 
with income at or below100 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. 

[23] 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. They do not 
include premium costs. Payments were adjusted for inflation using the 
Consumer Price Index for All Urban Consumers (CPI-U), 2010 dollars. 

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

[25] Cost sharing in Medicaid for most services is limited to nominal 
amounts. See [hyperlink, http://www.medicaid.gov/Medicaid-CHIP-Program-
Information/By-Topics/Cost-Sharing/Cost-Sharing.html] (accessed May 
24, 2013). 

[26] We 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 appendix III for more information on our 
scope and methodology.) 

[27] Congressional Budget Office, Geographic Variation in Health Care 
Spending, Pub. No. 2978 (Washington, D.C.: Feb. 2008). 

[28] For 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. 

[29] 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 [hyperlink, 
http://www.meps.ahrq.gov/mepsweb/data_files/publications/cb17/cb17.pdf].
 

[30] For this analysis, we used the 2003 RUCCs. This was the most 
recent data available at the time of our study. 

[31] 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 
[hyperlink, http://www.fairhealth.org/] for more information about 
FAIR Health and the dental claims data set. 

[32] Codes on Dental Procedures and Nomenclature are the intellectual 
property of the ADA as copyright owner. 

[33] American Dental Association, 2011 Survey of Dental Fees (Chicago, 
Ill.: December 2011). 

[End of section] 

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