The Distributed Breakdown of Dental Service Charges

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What does the distribution of billed charges really look like? 

It’s common to visualize the distribution of all billed charges for a dental services in an area to form a normal distribution.  

In a normal distribution, we would expect the average, median, and mode to be the same. This belief is further reinforced by U&C (Usual and Customary) reports that list out multiple percentiles.

Here's what a Normal Distribution looks like:

Gaussian Distribution Graph
Previously, we looked at the Dental Basket (most frequent 15 services by specialty). 

Here's a link to that article.

Let’s dig deeper into two of the services in the Dental Basket, as well as one that was not. 

D0120 (periodic oral evaluation - established patient) is the most frequently billed code.  

For general dentists, it accounts for 16.3% of billed services. By taking all the claims for a D0120 billed by GPs in the same zip code, the frequency of charges can be plotted by frequency. For example, the billed charge for 1,354 of 11,189 D0120 services was $78.00.

D0120 Distribution Graph

D1110 (prophylaxis – adult) is the second most frequently billed code.

For general dentists, it accounts for 16.1% of billed services. Based on 12,501 general practice claims from the same zip code:

D1110 Distribution Graph

D2740 (crown - porcelain/ceramic substrate) is not in the Dental Basket for GPs but is a common “emotional” code.  

Emotional codes are ones that are viewed by practices to be more important than they really are. For general dentists, it accounts for 1.4% of billed services.  Based on 998 general practice claims from the same zip code:

D2740 Distribution Graph

It gets even more interesting as we compare billed charges for individual practices against the market across the full spectrum of services.

It is common to have billed charges for the same practice to range to range from the 30th percentile for some services to the 80th percentile for others. The greater the variation, the more likely a practice will be losing revenue by billing less than the network’s allowed amount for some services.

Erick Paul
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