Quick Summary
When you visit your dentist for treatment, you might wonder how they decide what to charge for specific services. Each year, every provincial or territorial dental association produces a fee guide. These fee guides suggest a price for more than 1000 different dental procedures.
Dentists are not obliged to follow the guide but many base their fees on their dental association's suggested fee guide. These guides serve as a framework for dentists to develop their own pricing structure. From there dentists can set their fees according to what they feel is reasonable for the patient and the practice.
What to Expect in this Guide
In this guide, we will cover the following points:
- Explain what the dental fee guides are, when they are released and their purpose.
- Cover where to find these fee guides for your province.
- Explain the information in these fee guides and the codes used.
- Discuss why costs can differ from provincial guides.
- The connection between fee guides and insurance coverage, and what to ask your dentist.
What are the Provincial Fee Guides?
Each year, the dental association of every province and territory releases its fee guide. Usually, these guides are released at the beginning of the year. They are designed specifically for dental professionals as a reference point for setting their own service and procedure pricing.
These guides are quite technical and include all the codes (1000+) used in dentistry to describe and bill for specific dental services. Every code is allocated a specific price. Dentists can use these guides when planning their price lists. However, they are not obligated to follow these guides. They are free to set their own prices based on the structure of their practice, location, operating costs etc.
Where Can I Find the Fee Guide for My Province or Territory?
The complete fee guides are only available online to dental professionals registered with their dental associations and are not accessible to the public. Some dental associations allow hard copies of the guide to be purchased, but the costs can be high. Your local library may have a print or PDF copy of the complete fee guides. However, this is a technical document that can be hard for anyone other than dental professionals to understand fully.
Some dental associations, such as British Columbia and Alberta, have abbreviated versions of the guide available online. These abbreviated guides contain the codes and associated prices for dental treatments that are frequently needed, such as dental exams, x-rays and dental fillings. The abbreviated guides are easier to understand since they reference dental treatments that are familiar to most people.
You would need to discuss any questions regarding treatment codes with your dentist or dental office. Alternatively, you could contact your provincial or territorial dental association for further advice.
What Type of Information is Contained in the Provincial Fee Guides?
The information in the fee guides is extremely comprehensive. It is designed to cover a wide range of dental treatments. For example, the British Columbia Dental Association guide has over 1,400 codes.
The codes are from the Uniform System of Coding and List of Services (USC&LS) and are published annually by the Canadian Dental Association. The main use of these codes is in the production of fee guides and when submitting dental insurance claims.
Dentists are encouraged to use these codes to ensure treatment descriptions are uniform. When more than one code can be used to describe a treatment, dentists must use their judgment to choose the one most suitable.
While some codes are self-explanatory and easy to understand, such as "Standard Oral Examination," others are more complicated. For example, the billing code for a tooth-coloured filling depends on the number of tooth surfaces needing restoration. This is information that only your dentist would have.
Some treatments can require several codes. A routine dental hygiene appointment might appear to be a single treatment but combines two procedures, which are scaling and polishing. Each procedure has a different code.
The table below uses scaling and polishing as an example to show how two codes are needed.
| Code/ Treatment | Alberta | British Columbia | Saskatchewan |
|---|---|---|---|
| Polishing 11101 | $71.54 | $46.40 | $42.00 |
| Scaling 11111 | $80.30 | $55.80 | $52.00 |
The above figures were taken from the 2024 Provincial fee guides and are for one unit of time each. One unit is equivalent to 15 minutes of time in the dental chair.
The total cost of a hygiene appointment could be higher than the above figures if, for example, you need two units or 30 minutes of scaling. In that case, the cost of scaling your teeth would be double the prices quoted above.
Why Do My Dental Office Fees Differ from My Provincial Guide?
Provincial dental associations review the previous year's fee guides to determine a suitable yearly percentage increase. They consider factors like annual inflation and labour costs. Therefore, the increases are not fixed year to year. Each year, the percentage increase may be more or less based on these variables.
However, there is a limit to the factors considered which may not account for how overhead costs at an individual practice have changed.
Dental offices are private businesses, and when dentists review these updated guides, they must consider their operating costs when deciding on any fee increases for that year.
For example, rent in some cities like Vancouver is higher than in other parts of the province. Staff wages can be higher in more remote areas such as Northern Alberta. These costs must be factored in as they affect profit margins. The prices charged by a dentist must reflect these higher costs so the dentist can continue investing in their business.
Other factors are additional costs associated with running a business, such as accountancy fees, equipment maintenance or replacement.
How to Understand Your Dental Fees
When you see your dentist, they will likely follow the steps below.
- Oral exam.
- Explain any problems, a treatment plan, and a prognosis.
- Explanation of the cost of treatment and why they are charged before treatment begins.
- Description of any required dental lab fees, such as mouthguards or dentures.
Following these steps can help to eliminate misunderstandings about patient fees. When your dentist explains your treatment plan, ensure you understand why a treatment is needed and how it will help protect or restore dental health.
If you are unsure about any proposed fees, ask for further explanation. You can also ask for a second opinion. However, you might need to pay for another dental exam and other diagnostic costs.
How Can Provincial Fee Guides Affect Dental Insurance Plans?
Dental associations devise their fee guides independently of the insurance providers. Dental insurance providers do not work with dental associations when determining their fee coverage.
However, they may base their coverage on the codes and fees in these guides. Their coverage can be based on the previous year's guide, which could mean coverage is lower than the current provincial fee guide prices.
Other points to discuss with your dentist include:
- Is the entire cost of treatment covered? Your dental insurance might not cover the entire cost of the treatment plan proposed. In this case, you would be responsible for paying the difference between what your dental plan covers and the fees charged by your dentist. There might also be an annual cap on the coverage provided by your dental plan.
- Can your dentist submit a predetermination plan? Your dental office may be able to submit a predetermination plan to your dental insurance provider. This will confirm if a treatment plan is covered and if there are any out-of-pocket expenses.
- Can they submit a claim directly to the insurance company? Yes, some practices accept the assignment of benefits, which means they will bill your insurance provider directly. Otherwise, you might need to pay the total amount to the practice upfront and submit a claim to be reimbursed.
- Is a deposit required? Some dentists might want to take a deposit, especially if the proposed treatment plan requires significant time or expertise and must be scheduled.
Conclusion
Provincial fee guides are only a guide, and your dentist has no obligation to follow the fee schedule. If you do not feel comfortable with the treatment plan recommended by your dentist, always ask for clarification to better understand how the treatment will help restore your oral health or achieve your treatment goals.
Ensure you understand the proposed treatment plan before accepting it, including any lab fees.
*The content provided in this article, including text, graphics, and referenced material, is intended for informational purposes only and is not a substitute for professional dental advice, diagnosis, or treatment. Always consult with your dentist or another qualified oral health professional for questions regarding your dental condition. Never disregard professional dental advice or delay seeking it based on information from this article. If you believe you have a dental emergency, contact your dentist, or seek immediate assistance from an oral healthcare professional.