Declining Fee Schedules.
We use the National Dental Advisory Service Comprehensive Fee Report to set our prices. Established in 1981 by a dentist named Yale Wasserman, the report uses survey and claims data to provide a comprehensive summary of fees for dental procedures broken down by ZIP code. The report is a fantastic tool that allows us to objectively set our fees relative to the market.
But things can’t be that simple…
We participate in two dental networks:
Dental Network of America (DNOA) - used primarily by Blue Cross Blue Shield of Illinois
Connection Dental - used by Humana, United Healthcare, Principal, Mutual of Omaha, and others
As a result of our participation in those two networks, we agree to forego our office fees in favor of the contracted fees defined by DNOA and Connection Dental. We get the benefit of the patient network insured by the carriers using DNOA and Connection Dental and the patients get the benefit of the network discounts incurred through us agreeing to use DNOA and Connection Dental Fees.
As a general matter, in-network fees are much lower than dental office fees. For example, consider an adult cleaning (i.e., Prophylaxis - ADA Code D1110):
Hofmeister Family Dentistry = $135.00
DNOA rate = $72.63 (54% of our office fees)
Connection Dental rate = $79.00 (59% of our office fees)
We adjust our office fees every two years to make sure that we stay competitive in the market and to adjust for inflation. None of our operating costs get cheaper over time (e.g., labor costs go up, rent goes up, dental supplies go up, liability insurance goes up, software prices go up). We do our best to constrain price increases in the face of these operational cost increases. But such is the nature of business. Conversely, since we purchased the business in April 2021, the DNOA and Connection Dental in-network fees have either stayed static or have decreased. I wanted to spend some time in this blog to demonstrate this trend as evidenced by the DNOA fee schedule update from 2024 to 2025 (which we just received at our office earlier this week).
Summarily, across the 800+ ADA codes for which fees are provided, 2025 DNOA fees are 0.82% less than they were in 2024. That means that if a procedure fee in 2024 was $100, the 2025 fee would be $99.18. But it’s useful to dive into the different ADA code categories to get a clearer picture of what’s going on:
Preventative services (e.g., cleanings, exams, and x-rays) are down 1.52%
Basic restorative services (e.g., fillings) are down 2.80%
Major restorative services (e.g., crowns) are down 2.30%
Endodontic services (e.g., root canals) are up 8.35%
Periodontic services are up 6.39%
Prosthodontic services (e.g., dentures) are down 2.6%
Oral Surgery services (e.g., wisdom teeth extraction) are down 1.38%
Orthodontic services (e.g., braces) are up 0.22%
At our practice, we focus on: (1) preventative services; (2) basic restorative services; (3) major restorative services; and (4) prosthodontic services. Those areas are down 2.06% compared to 2024. I don’t have any insight into DNOA pricing strategy. I just know that in the face of unprecedented inflation over the past 4 years, DNOA has decreased their fees on aggregate and even more so for the preventative services that the vast majority of people need. While these dynamics force us to be innovative in how we run our business and how we deliver care (a good thing), it creates tremendous pressure that at some point in the future will force us to make business decisions at the expense of delivering care (most likely as a function of leaving certain networks that we feel we can no longer afford). It makes me question who is advocating (and to what extent) for general dentists and the vital preventative services we perform. Where is the ADA? Where is the AGD? Where is the CDS? Advocacy is tricky thing and typically represents a narrow slice of any industry. But the extent to which we’ve seen static/decreasing levels of reimbursement from one of the largest national dental networks is troubling. We’ll figure it out. But it’s a headwind nonetheless.