Revenue and ROI
Dental Fee Schedule Comparison Calculator
Compare annual dental revenue under two carriers or PPO fee schedules for the same procedure mix, with an optional reference schedule.
Estimated result
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Annual revenue under carrier A
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Annual revenue under carrier B
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Difference (B minus A)
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- Difference as a percent of carrier A
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- Annual revenue at reference fees
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- Carrier A as a percent of reference fees
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- Carrier B as a percent of reference fees
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Estimates only, based on your inputs and the assumptions below. Not a guarantee of results or professional advice. Inputs stay in your browser.
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Quick answer
What does the dental fee schedule comparison calculator measure?
A dental fee schedule comparison weighs two carriers' PPO fees against the same annual procedure volume. This calculator multiplies each CDT code line by the fee under carrier A and carrier B, totals both, and shows the dollar and percent difference. Add a reference schedule to express each as a percent of it.
Formula
Line revenue = Annual volume x Fee
Calculated for each procedure line under carrier A, carrier B and, if entered, the reference schedule.
Total A = sum of (Volume x Carrier A fee); Total B = sum of (Volume x Carrier B fee)
The same volumes are used for both carriers so the comparison isolates the fees.
Difference = Total B - Total A; Difference % = Difference / Total A x 100
Positive values mean carrier B pays more for this mix.
Percent of reference = Carrier total / sum of (Volume x Reference fee) x 100
Only shown when every line with volume has a reference fee, so the totals cover the same procedures.
Worked example
A dental practice compares two PPO fee schedules across three CDT code lines: 2,000 procedures at $100 (carrier A) or $110 (carrier B), 1,200 at $140 or $135, and 500 at $200 or $220. Carrier A totals 200,000 + 168,000 + 100,000 = $468,000; carrier B totals 220,000 + 162,000 + 110,000 = $492,000, a difference of $24,000 (24,000 / 468,000 = 5.13%). At reference fees of $90, $120 and $180 the mix is worth 180,000 + 144,000 + 90,000 = $414,000, so carrier A is 468,000 / 414,000 = 113.04% of the reference schedule and carrier B is 492,000 / 414,000 = 118.84%.
| Procedure line 1: annual volume | 2,000 |
|---|---|
| Procedure line 1: carrier A fee | $100.00 |
| Procedure line 1: carrier B fee | $110.00 |
| Procedure line 1: reference fee (optional) | $90.00 |
| Procedure line 2: annual volume | 1,200 |
| Procedure line 2: carrier A fee | $140.00 |
| Procedure line 2: carrier B fee | $135.00 |
| Procedure line 2: reference fee (optional) | $120.00 |
| Procedure line 3: annual volume | 500 |
| Procedure line 3: carrier A fee | $200.00 |
| Procedure line 3: carrier B fee | $220.00 |
| Procedure line 3: reference fee (optional) | $180.00 |
| Annual revenue under carrier A | $468,000 |
| Annual revenue under carrier B | $492,000 |
| Difference (B minus A) | $24,000 |
| Difference as a percent of carrier A | 5.13% |
| Annual revenue at reference fees | $414,000 |
| Carrier A as a percent of reference fees | 113.04% |
| Carrier B as a percent of reference fees | 118.84% |
Assumptions and limits
- Fees are allowed amounts per procedure (what the carrier recognizes, including the patient coinsurance), not your full office fees.
- Volume is the same under both carriers. A network change that shifts patients to or from the practice is not modeled.
- The reference schedule, if used, should cover the same CDT codes and year as the carrier fees.
- Denials, frequency limits, downgrades, annual maximums and payment timing are not included.
Frequently asked questions
What is a dental fee schedule?
A dental fee schedule is a list of fees by CDT code. Your office keeps its own full fee schedule, and each PPO carrier you join sets a contracted fee schedule with the most it will allow for each code. The gap between the two becomes your write-off, so comparing carrier schedules against your real procedure mix shows what each contract is worth.
How do you compare two dental PPO fee schedules?
Apply both fee schedules to the same list of CDT codes and annual volumes, then total each. Comparing fee by fee can mislead because a carrier may pay more for codes you rarely bill and less for the hygiene and diagnostic codes you bill most. Weighting by your real volume shows which schedule is worth more to your practice.
What is a reference fee schedule?
A reference fee schedule is a third set of fees you measure both carriers against, such as your state Medicaid dental fees or the same carrier's fees from last year. Expressing each carrier as a percent of the same reference makes it easier to see how far apart they are and how fees have moved over time.
Where do I find my PPO fee schedules?
Most dental carriers provide your contracted fee schedule through their provider portal or on request from provider relations, and many practice management systems store a fee schedule for each carrier. Make sure the schedule is current for your location and contract, and use the same effective year for every line in the comparison.
Which procedures should I include in the comparison?
Include the CDT codes that make up most of your production with the carriers being compared, usually periodic and comprehensive exams, prophylaxis, bitewings, common restorations, crowns and periodontal maintenance. For many offices, a handful of codes covers most of the allowed amount. You can group similar codes into one line by using a weighted average fee.
Is a higher fee schedule always the better dental contract?
No. Frequency limits, downgrade and alternate benefit clauses, attachment requirements, waiting periods, payment speed and how many of your patients the plan covers all affect what you actually collect. A slightly lower fee schedule with fewer downgrades can be worth more. Review those terms alongside the fees before joining or leaving a network.
Written by the Texas Solutions RCM team. Last reviewed . General information, not legal or coding advice; payer rules vary.
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