The ADA Council on Dental Benefit Programs said dentists should report their full fee when submitting dental claim forms for services reported to third-party payers. The council also encouraged dentists to review PPO agreements annually and to discuss potential increases in fee schedules with payers. The ADA's contract negotiations toolkit may be helpful when renegotiating clauses and fee schedules.

What fee should a dentist indicate on your dental claim forms?

A full fee is the fee for a service that is set by the dentist, which reflects the costs of providing the procedure and the value of the dentist’s professional judgment. A contractual relationship does not change the dentist’s full fee. Therefore, the ADA recommends that it is always appropriate to report the full fee, in box 31 of the dental claim form, for each service reported to a third-party payer. 

Do you have a dental insurance question or concern?  If so, you may reach out to the ADA Third Party Payer Concierge by calling 800-621-8099 or at dentalbenefits@ada.org.  This is a free service for ADA members.