© 2016 American Dental Association All Rights Reserved.
April 2016 (Revised)
An Analysis of Dental Spending Among
Children with Private Dental Benefits
Authors: Cassandra Yarbrough, M.P.P.; Marko Vujicic, Ph.D.; Krishna
Aravamudhan, B.D.S., M.S.; Scott Schwartz, D.D.S.; Barry Grau, B.A.
Introduction
The passage of the Affordable Care Act (ACA) brought many changes to the oral health
sector in the United States. Chief among them was a continued focus on the importance of
children’s oral health. Child dental benefits are one of ten essential health benefits under the
ACA.
1
While there are implementation challenges, children are gaining dental benefits
through the new health insurance marketplaces,
2
and more medical plans are including
dental coverage for children.
3
Given all of these changes, the ADA Health Policy Institute (HPI) is examining the cost
implications of alternative dental benefits options available for children within the health
insurance marketplaces. To do this, it is necessary to first understand typical dental care
utilization and spending patterns among children who currently have private dental benefits.
This information could then be used to “predict” dental care utilization patterns of newly
insured children. Based on predicted utilization patterns, costs associated with alternative
dental benefits plans offered in the health insurance marketplaces could be simulated.
The Health Policy Institute (HPI)
is a thought leader and trusted
source for policy knowledge on
critical issues affecting the U.S.
dental care system. HPI strives
to generate, synthesize, and
disseminate innovative research
for policy makers, oral health
advocates, and dental care
providers.
Who We Are
HPI’s interdisciplinary team of
health economists, statisticians,
and analysts has extensive
expertise in health systems
policy research. HPI staff
routinely collaborates with
researchers in academia and
policy think tanks.
Contact Us
Contact the Health Policy
Institute for more information on
products and services at
[email protected]
or
call 312.440.2928.
Key Messages
More than one in four children ages 1 through 18 with private dental benefits do not have
a single dental claim within the year.
Fees paid to dentists through private dental benefits plans are significantly lower than
market fees. This leads to substantial differences in total dental spending estimates
based on “market” versus “actual” fees.
For the majority of children, total copayments, coinsurance, and premiums exceed the
“market” value of dental care.
Research Brief
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In this research brief, we summarize our findings from
the first step of this analysis. Specifically, we analyze
dental care utilization and spending patterns among a
very large sample of children with private dental
benefits. We analyze utilization and spending by dental
service category, age group and spending quartile. To
our knowledge, this is the first analysis of dental
spending patterns at the procedure level among a
large sample of children with private dental benefits.
Results
Table 3 summarizes average annual dental spending
valued at market fees. For ages 1 through 6, this is
estimated to be $257 and ranges from $160 for
children in the lowest quartile of spending to $996
among children in the highest quartile of spending. We
find that 42.5 percent of children ages 1 through 6 who
have private dental benefits do not have a single dental
claim within the year.
Among children ages 7 through 12, average annual
dental spending, valued at market fees, is estimated to
be $828. This ranges from $247 among children in the
lowest quartile of spending to $2,921 among children in
the highest quartile of spending. It is important to note
that average total dental spending in this age category
is largely influenced by the spending on orthodontia
services among children in the fourth quartile.
Additionally, 20.9 percent of children ages 7 through 12
who have private dental benefits do not have a single
dental claim within the year.
Among children ages 13 through 18, average annual
dental spending, valued at market fees, is estimated to
be $928. This ranges from $273 among children in the
lowest quartile of spending to $3,580 among children in
the highest quartile of spending. Similar to children
ages 7 through 12, total dental spending among
children ages 13 through 18 is largely influenced by
spending on orthodontia services among children in
the third and fourth spending quartiles. Furthermore,
27.6 percent of children ages 13 through 18 who have
private dental benefits do not have a single dental
claim within the year.
Among all children ages 1 through 18 who have private
dental benefits in our sample, 28.8 percent do not have
a single dental claim within the year.
Table 4 summarizes estimated average annual dental
spending, valued at market fees, by age group and
dental spending quartile, replicating the “total” rows
from Table 3.
Table 5, in comparison, summarizes average annual
dental spending valued at actual fees paid to dentists
under dental benefits plans for children with private
dental benefits. For children ages 1 through 6, this is
estimated to be $182. This ranges from $95 among
children in the lowest quartile of spending to $719
among children in the highest quartile of spending.
Average annual dental spending, valued at actual fees
paid to dentists, among children with private dental
benefits ages 7 through 12 is estimated to be $416.
This ranges from $133 among children in the lowest
quartile of spending to $1,321 among children in the
highest quartile of spending.
Average annual dental spending, valued at actual fees
paid to dentists, among children with private dental
benefits ages 13 through 18 is estimated to be $505.
This ranges from $134 among children in the lowest
quartile of spending to $1,926 among children in the
highest quartile of spending.
Table 6 summarizes estimated average annual dental
spending, valued at actual fees paid to dentists, by age
group and dental spending quartile, replicating the
“total” rows from Table 5. Note, neither Table 5 nor
Table 6 include spending on dental benefits plan
premiums.
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Table 7 summarizes average annual dental spending,
valued at actual fees paid to dentists, by age group
and dental spending quartile broken down by source of
financing. Specifically, it summarizes the portion of
dental spending that is paid by the insurer and the
patient. We also calculate total outlays that incorporate
estimated dental benefits plan premium costs.
Discussion
To our knowledge, this is the first comprehensive
analysis of dental care utilization and spending
patterns among children with private dental benefits. In
our view, there are several findings with important
implications for consumers and employers, the main
purchasers of private dental benefits.
First, a significant portion of beneficiaries do not use
any of their dental benefits. More than one in four
children ages 1 through 18 who have private dental
benefits do not have a single dental claim within the
year. For children ages 1 through 6, this is much higher
at 42.5 percent. Clearly, a significant portion of children
are not receiving routine preventive dental care.
Second, it is clear that fees paid to dentists through
private dental benefits plans are significantly lower
than market fees. This leads to substantial differences
in total dental spending estimates based on “market”
versus “actual” fees, especially within the higher
spending quartiles.
Third, and most significant in our view, for the majority
of children, total spending after including premiums
actually exceeds the “market” value of their dental
care. This can be seen by comparing Table 1, Table 4
and the bottom panel in Table 7. It is important to note
that this result holds for several age-spending quartiles
as well as for all children taken together.
It is important to note that while we used ACA
marketplace stand-alone dental plan premium
estimates in our calculation of the total cost of dental
benefits to the patient, we feel our analysis is very
relevant for group dental benefits plans purchased by
employers outside of the ACA marketplaces.
Employer-sponsored dental benefits plan information
from the National Association of Dental Plans indicates
that dental preferred provider organization plans
(DPPOs) are by far the most common type of plan
offered by employers.
4
Our estimate for premiums in
our analysis is on par with typical premiums charged
for DPPO products (for fully insured business lines)
sold outside of the marketplaces.
5
Thus, we feel that
observations regarding total spending on care versus
total cost of premiums and patient out-of-pocket
expenses hold true beyond the ACA marketplaces.
Looking forward, the ACA and other developments in
the dental sector have the potential to reshape the
dental benefits products available to consumers. The
ADA Health Policy Institute will continue to study the
impact of the ACA on dental benefits coverage, as well
as other important outcomes.
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Table 1: Total Number of Children in Sample by Age Group and Dental Spending Quartile
Ages Total No Spending First Second Third Fourth
1 through 6 497,082 211,079 71,558 71,789 71,085 71,571
7 through 12 720,583 150,625 142,085 142,475 142,904 142,494
13 through 18 837,691 230,814 152,067 151,368 151,684 151,758
Source: ADA HPI analysis of 2013 Truven data.
Table 2: Utilization Rate for the Top 25 Most Common Procedures
Ages 1 through 18 Ages 1 through 6 Ages 7 through 12 Ages 13 through 18
D0120 0.950 D1120 0.854 D1120 1.264 D0120 0.952
D1120 0.764 D0120 0.677 D0120 1.137 D1110 0.804
D1208 0.568 D1208 0.485 D1208 0.759 D1208 0.454
D1110 0.332 D0272 0.251 D0272 0.527 D0274 0.373
D0272 0.307 D1206 0.185 D1351 0.526 D8670 0.315
D1351 0.306 D0150 0.185 D1206 0.229 D1120 0.281
D0274 0.196 D0220 0.150 D0220 0.200 D1351 0.246
D8670 0.185 D0230 0.138 D0230 0.170 D0272 0.151
D1206 0.182 D1351 0.089 D8670 0.161 D2391 0.150
D0220 0.167 D2392 0.079 D7140 0.160 D0230 0.148
D0230 0.153 D2150 0.075 D2392 0.120 D0220 0.148
D0150 0.123 D9230 0.054 D0274 0.115 D1206 0.139
D2392 0.108 D0240 0.051 D2150 0.110 D2392 0.116
D2391 0.103 D2930 0.046 D0150 0.109 D7240 0.111
D7140 0.085 D1203 0.046 D0330 0.098 D0330 0.100
D2150 0.084 D2391 0.043 D2391 0.090 D0150 0.098
D0330 0.082 D0140 0.039 D1203 0.086 D2140 0.096
D2140 0.071 D2140 0.038 D9230 0.075 D2150 0.068
D1203 0.057 D7140 0.034 D2140 0.066 D0140 0.062
D0140 0.055 D0145 0.032 D0140 0.057 D8080 0.056
D9230 0.048 D3220 0.030 D8060 0.046 D7140 0.052
D7240 0.046 D0330 0.028 D8080 0.031 D0210 0.040
D8080 0.034 D2330 0.019 D0210 0.031 D1203 0.039
D0210 0.030 D0274 0.016 D7111 0.024 D7230 0.036
D0240 0.021 D1330 0.012 D2930 0.022 D9220 0.036
Source: ADA HPI analysis of 2013 Truven data. Notes: Analysis is based on all children with private dental benefits
regardless of their dental spending level (i.e. includes children with no spending).
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Table 3: Estimated Average Annual Dental Spending, Valued at Market Fees (per FAIR Health), by
Category of Dental Service, Age Group and Dental Spending Quartile in 2015 Dollars
Category of Dental Service All First Second Third Fourth
Ages 1 through 6
Preventive/Diagnostic $168 $156 $255 $338 $420
Basic $80 $4 $8 $28 $513
Major $6 $0 $1 $2 $36
Orthodontia $4 $0 $1 $1 $27
Total $257* $160 $265 $369 $996
Ages 7 through 12
Preventive/Diagnostic $280 $214 $338 $412 $452
Basic $125 $13 $36 $131 $452
Major $9 $1 $1 $5 $37
Orthodontia $414 $18 $24 $72 $1,981
Total $828 $247* $399 $620 $2,921*
Ages 13 through 18
Preventive/Diagnostic $239 $213 $338 $401 $366
Basic $201 $17 $47 $217 $828
Major $42 $3 $3 $17 $208
Orthodontia $447 $40 $46 $204 $2,178
Total $928* $273 $434 $839 $3,580
Source: ADA HPI analysis of 2013 Truven claims data, 2012 and 2013 FAIR Health procedure charges. Notes: Analysis for
“All” includes all children with private dental benefits regardless of dental spending (i.e. includes children with no spending).
Analysis for spending quartiles excludes individuals with no dental spending. *Spending categories do not sum to total due to
rounding.
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Table 4: Estimated Average Annual Dental Spending, Valued at Market Fees (per FAIR Health), by Age
Group and Dental Spending Quartile in 2015 Dollars
Ages All First Second Third Fourth
1 through 6 $257 $160 $265 $369 $996
7 through 12 $828 $247 $399 $620 $2,921
13 through 18 $928 $273 $434 $839 $3,580
Source: ADA HPI analysis of 2013 Truven claims data, 2012 and 2013 FAIR Health procedure charges. Notes: Analysis for “All”
includes all children with private dental benefits regardless of dental spending (i.e. includes children with no spending). Analysis
for spending quartiles excludes individuals with no dental spending.
Table 5: Estimated Average Annual Dental Spending, Valued at Actual Fees Paid (per Truven), by
Category of Dental Service, Age Group, and Dental Spending Quartile in 2015 Dollars
Category of Dental Service All First Second Third Fourth
Ages 1 through 6
Preventive/Diagnostic $127 $94 $175 $261 $357
Basic $52 $1 $3 $13 $342
Major $2 $0 $0 $0 $15
Orthodontia $1 $0 $0 $0 $5
Total $182 $95 $178 $274 $719
Ages 7 through 12
Preventive/Diagnostic $209 $129 $232 $320 $377
Basic $81 $4 $16 $72 $317
Major $4 $0 $0 $1 $20
Orthodontia $121 $0 $1 $6 $606
Total $416* $133 $248* $399 $1,321*
Ages 13 through 18
Preventive/Diagnostic $176 $127 $235 $319 $289
Basic $132 $5 $19 $123 $584
Major $26 $1 $1 $6 $135
Orthodontia $171 $1 $2 $24 $917
Total $505 $134 $257 $472 $1,926*
Source: ADA HPI analysis of 2013 Truven claims data, 2012 and 2013 FAIR Health procedure charges. Notes: Analysis for
“All” includes all children with private dental benefits regardless of dental spending (i.e. it includes children with no spending).
Analysis for spending quartiles excludes individuals with no dental spending. *Spending categories do not sum to total due to
rounding.
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Table 6: Estimated Average Annual Dental Spending, Valued at Actual Fees Paid (per Truven), by Age
Group and Dental Spending Quartile in 2015 Dollars
Ages All First Second Third Fourth
1 through 6 $182 $95 $178 $274 $719
7 through 12 $416 $133 $248 $399 $1,321
13 through 18 $505 $134 $257 $472 $1,926
Source: ADA HPI analysis of 2013 Truven claims data, 2012 and 2013 FAIR Health procedure charges. Notes: Analysis for “All”
includes all children with private dental benefits regardless of dental spending (i.e. includes children with no spending). Analysis for
spending quartiles excludes individuals with no dental spending.
Table 7:
Estimated Average Annual Dental Spending, Valued at Actual Fees Paid (per Truven), by Age
Group and Dental Spending Quartile in 2015 Dollars
Ages All First Second Third Fourth
Dental Spending Paid
by Insurer
1 through 6 $161 $92 $172 $261 $592
7 through 12 $317 $128 $235 $361 $880
13 through 18 $359 $127 $242 $411 $1,200
Dental Spending Paid
by Patient (Not
Including Estimated
Premium Cost)
1 through 6 $21 $3 $6 $13 $126
7 through 12 $98 $5 $13 $38 $441
13 through 18 $146 $7 $15 $61 $726
Dental Spending
(Including Estimated
Premium Cost)
1 through 6 $403 $385 $387 $395 $508
7 through 12 $480 $387 $394 $420 $822
13 through 18 $527 $388 $397 $442 $1,107
Source: ADA HPI analysis of 2013 Truven claims data, 2012 and 2013 FAIR Health procedure charges. Notes: Analysis for “All”
includes all children with private dental benefits regardless of dental spending (i.e. includes children with no spending). Analysis for
spending quartiles excludes individuals with no dental spending.
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Data & Methods
Child dental benefits in dental plans offered in the
federally-facilitated marketplace include four main
categories of dental services: check-up, basic, major
and orthodontia. For the purposes of this analysis, we
used these four categories and renamed the category
“check-up” as “preventive and diagnostic services.”
We categorized children in our analysis based on two
factors: age group and total dental spending within the
year.
We created age groups based on tooth eruption
patterns and potential dental needs. Eruption of
permanent teeth occurs between 6 and 12 years of
age, so we created three age groups: 1 through 6, 7
through 12, and 13 through 18.
6
To calculate dental care utilization, we used data from
the Truven Health MarketScan® Research Databases
(Truven) for 2013.
7
Truven includes dental claims and
enrollment data from large employers and health plans
across the United States who provided private dental
benefits to employees, their spouses and dependent
children. In 2013, there were 10.7 million covered lives
included in Truven. Based on the latest data from the
2012 Medical Expenditure Panel Survey (MEPS),
8
we
estimate that as of 2012, Truven covered about 7.6
percent of privately insured individuals in the United
States. Truven includes claims from a variety of fee-
for-service (FFS), preferred provider organization
(PPO) and capitated health plans.
We examined 11,423,879 dental claims across
2,055,356 children who were enrolled in a private
dental benefits plan for 365 continuous days in our
analysis.
Each Truven dental claim indicates the age of the child
for which the claim was submitted, the American
Dental Association Current Dental Terminology
(CDT®) procedure code, and the total amount spent
per procedure. Within each age group, we analyzed
data across all children with private dental benefits,
regardless of whether they had any dental spending.
We also generated dental spending quartiles,
separating those with no dental spending into a
separate fifth group. Total dental spending includes
payments made by consumers (e.g. copayments,
coinsurance, etc.), insurers and other third parties.
Truven captures all of these parameters.
See Table 1 for the total number of children in each
age group and dental spending quartile included in our
analysis, hereinafter referred to as “patient profiles.”
With beneficiaries sorted into groups by their dental
spending levels, we analyzed the utilization of specific
dental procedures within each patient profile using
CDT® codes. To determine the average number of
times a child within each patient profile utilized a
specific dental procedure within the year, we divided
the total number of claims for a procedure by the total
number of individuals within each patient profile. This
generates an average utilization rate for each dental
procedure that is specific to each age group and dental
spending quartile (i.e. for each patient profile). We did
this for every dental procedure. Table 2 summarizes
the utilization rate for the 25 most frequently used
procedures within each age group.
We calculated the average utilization rate slightly
differently for three orthodontia procedures: D8070,
D8080 and D8090. These procedures are
comprehensive orthodontia procedures and should not
be billed together or more than once per year.
However, many dental benefits plans will disperse
provider reimbursement for these procedures over the
course of 12 to 18 months,
9
resulting in multiple paid
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claims with the same procedure code per child. Indeed,
we found this to be the case within the 2013 Truven
data we analyzed. For our analysis, we needed to
count each of these procedures only once per year per
child. To accomplish this, we added up spending
across procedure codes D8070, D8080 and D8090 in
2013 and when there were multiple instances of these
procedures, we set the frequency to once per year. In
other words, if a child had two or more claims for these
procedures within a year, total spending was summed
up and allocated to the procedure code used on the
last claim paid in 2013. Had we not made this
adjustment, we would be potentially overestimating the
frequency of comprehensive orthodontia procedures.
We calculated total dental spending based on these
dental care utilization profiles in two ways. Our first
method used actual reimbursement amounts from the
Truven database. It is important to note that Truven is
a database of dental spending based on
reimbursement rates to providers that have been
negotiated with private dental benefits plans. Truven
does not necessarily represent what providers would
typically charge for dental procedures. We break down
dental spending according to what is paid by the
insurer and the patient. We also calculate total patient
outlays, including estimated dental benefits plan
premium costs. We used the Consumer Price Index
(CPI) inflation calculator from the United States Bureau
of Labor Statistics to adjust these 2013 average
payments to 2015 dollars.
10
We use $381.36 as the
estimated annual premium cost, which is the
annualized average cost of a pediatric stand-alone
dental plan in the federally-facilitated marketplace in
2015.
11,12
This premium estimate is also roughly in line
with average premiums for dental PPO plans sold in
the employer market.
4,5
Our second method estimated dental spending based
on “market fees.” To determine how much dentists
typically charge for each procedure, we obtained
commercial dental benefits plan reimbursement
charges from the 2012 and 2013 FAIR Health Dental
Benchmark Module.
13
The most recent data contained
within the FAIR Health database cover 125 million
individuals with commercial dental benefits,
14
capturing
approximately 80 percent
15
of the total commercial
dental benefits market. The FAIR Health database
provides charge data for dental procedures billed using
CDT® codes, reporting reimbursement rates charged
by providers before network discounts are applied.
Thus, we use these charge data to estimate dental
spending at market fees.
We used average national charges from the 2013 FAIR
Health database, substituting data from the 2012 FAIR
Health dataset when 2013 data were not available.
FAIR Health does not include average national
charges for orthodontia procedures. We substituted
average national charges from the ADA’s 2013 Survey
of Dental Fees for these procedures.
16
The ADA 2013
Survey of Dental Fees was sent to a simple random
probability sample of 13,052 ADA member and non-
member general practitioners and specialists.
Specialists, such as orthodontists, were oversampled
with respect to their proportion in the population. The
response rate for the 2013 Survey of Dental Fees was
18.2 percent, and appropriate weights were applied to
reflect the population.
We used the CPI inflation calculator from the United
States Bureau of Labor Statistics to adjust FAIR Health
and ADA 2013 Survey of Dental Fees charges to 2015
dollars.
10
We multiplied the 2015 procedure charges by
the corresponding utilization rate to determine the
average spending per dental procedure per beneficiary
in each of our patient profiles.
For some procedure codes, Truven data indicated
there were no insurer or consumer out-of-pocket
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payments. We substituted in the charged amount for
these procedures under the assumption that when
there are no payments associated with a procedure,
then it is not covered by a dental benefits plan and the
consumer pays for the procedure out of pocket at the
price charged by the provider. We recognize that in
some cases, the provider may not charge the patient
for procedures that are not covered by a dental
benefits plan, instead providing such procedures free
of charge. However, to be conservative, we maximized
total average dental spending by consumers in
assuming that providers do charge patients their
market fee for non-covered services. We examined the
total estimated value of these procedures and it was
negligible; using the charged amount for these
procedures did not change any of the results.
We grouped dental procedures and associated
spending into broad categories. We reviewed 2013 and
2015 Federal Employee Dental and Vision Plan
(FEDVIP) information to assign each procedure to a
service category: preventive and diagnostic, basic,
major and orthodontia.
17
Several procedures were not
specifically referenced in any of the FEDVIP plans we
reviewed. Additionally, several procedures were
categorized as general services. For those procedures
that were not specifically referenced in any of the
FEDVIP plans we reviewed, we referenced dental
benefits industry reports and reviewed several stand-
alone dental plans offered in the 2015 federally-
facilitated marketplace for potential categorizations.
The majority of these procedures were crowns and oral
surgery codes. After our review, we categorized
crowns as major services
18
and oral surgery
procedures as basic services.
19
While we understand
that not all procedures are covered by every dental
benefits plan, our goal was to include as many
procedures in our patient profiles as possible in order
to accurately reflect total spending on dental services
by children in our sample.
The majority of the remaining uncategorized
procedures were related to anesthesia or sedation. We
reviewed a random sample of stand-alone dental plans
offered through the 2015 federally-facilitated
marketplace to understand how the dental benefits
industry tends to classify these procedures.
20
For
pediatric patients, a majority of these plans classified
such procedures as basic services. We also solicited
advice from the American Academy of Pediatric
Dentists who explained that, in most situations, such
services would be classified as basic services for
pediatric patients.
21
However, in an effort to be
conservative, we decided to split total spending on
these procedures evenly between basic and major
spending.
Finally, there were 56 non-orthodontia procedures for
which there was no corresponding charge data in the
FAIR Health database and 12 orthodontia procedures
for which there was no corresponding charge data in
the ADA 2013 Survey of Dental Fees. We dropped
these procedures from our analysis. Additionally, if a
procedure was not covered under the FEDVIP plan
and we could not find supporting documentation for
classification from another source, we dropped it from
our analysis. This resulted in dropping an additional 38
procedures.
22
It is important to note that dropping
these 38 procedures from the analysis had almost no
effect on our dental spending calculations. In fact, the
dental procedures retained in our analysis account for
99.9 percent of total dental spending across our
sample.
A limitation in our analysis is that we do not capture the
use of dental services for which no claims were
submitted on behalf of the beneficiary. We have no
way of identifying the extent to which providers for
commercially insured children do not submit a claim to
the child’s dental plan. However, in our data, there are
claims for which the insurer did not cover any of the
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charged amount. This strongly suggests that the
Truven data are indeed capturing utilization of
procedures even in the case where the dental plan
does not cover any of the cost.
This Research Brief was published by the American Dental Association’s Health Policy Institute.
211 E. Chicago Avenue
Chicago, Illinois 60611
312.440.2928
[email protected]
For more information on products and services, please visit our website, www.ada.org/hpi.
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References
1
HealthCare.gov. 10 health care benefits covered in the health insurance marketplace. August 22, 2013. Available
from: https://www.healthcare.gov/blog/10-health-care-benefits-covered-in-the-health-insurance-marketplace/. Accessed
August 28, 2015.
2
Yarbrough C., Vujicic M., Nasseh K. Update: Take-Up of Pediatric Dental Benefits in Health Insurance Marketplaces
Still Limited. Health Policy Institute Research Brief. American Dental Association. May 2014. Available from:
http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_0514_1.ashx. Accessed October
19, 2015.
3
Yarbrough C, Vujicic M, Nasseh K. More dental benefits options in 2015 Health Insurance Marketplaces. Health Policy
Institute Research Brief. American Dental Association. February 2015. Available from:
http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_0215_1.ashx. Accessed October
19, 2015.
4
National Association of Dental Plans. 2014 State of the Dental Benefits Market. March 2015.
5
National Association of Dental Plans. Dental Benefits Choices for Children One Size Does Not Fit All. Available from:
http://www.nadp.org/docs/default-source/gr-documents/dental-benefit-choices-for-children_5-5-15_v14-2.pdf?sfvrsn=2.
Accessed November 11, 2015.
6
American Dental Association. Eruption charts. Mouth Healthy. Available from: http://www.mouthhealthy.org/en/az-
topics/e/eruption-charts. Accessed October 21, 2015.
7
Analysis available upon request. Conducted July through December 2015.
8
Medical Expenditure Panel Survey (MEPS). MEPS HC-155: 2012 Full Year Consolidated Data File. Agency for
Healthcare Research and Quality. September 2014. Available from:
http://meps.ahrq.gov/mepsweb/data_stats/download_data_files_detail.jsp?cboPufNumber=HC-155. Accessed August
10, 2015.
9
Email communication with the American Association of Orthodontics. November 19, 2015.
10
U.S. Bureau of Labor Statistics. CPI Inflation Calculator. Available from: http://data.bls.gov/cgi-bin/cpicalc.pl.
Accessed July 31, 2015.
11
Yarbrough C, Vujicic M, Nasseh K. More dental benefits options in 2015 Health Insurance Marketplaces. Health
Policy Institute Research Brief. American Dental Association. February 2015. Available from:
http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_0215_1.ashx. Accessed October
19, 2015.
12
To estimate the average annual premium cost of dental benefits, we drew upon previous research.
8
In 2015, the
average monthly cost of a high actuarial value child stand-alone dental plan sold through the federally-facilitated
marketplace was $35.95. The average monthly cost of a low actuarial value child stand-alone dental plan sold through
the federally-facilitated marketplace was $27.61. We took the average of these two monthly costs ($31.78) and
multiplied that average by 12 months to estimate the annual cost of purchasing stand-alone dental benefits for a child.
This yielded an average annual cost of $381.36.
13
FAIRHealth, Inc. Standard Products. Dental Module. Undated. Available at: http://www.fairhealth.org/DataSolution.
Accessed September 18, 2014.
14
FAIRHealth, Inc. Undated. Available at: http://www.fairhealth.org/. Accessed September 19, 2014.
15
Based on data from the 2012 Medical Expenditure Panel Survey (MEPS), there were 155.9 million individuals in the
U.S. with commercial dental insurance. Eighty percent of 155.9 million is 125 million. Agency for Healthcare Research
and Quality (AHRQ). MEPS HC-155: 2012 Full Year Consolidated Data File. September 2014. Available at:
http://meps.ahrq.gov/mepsweb/data_stats/download_data_files_detail.jsp?cboPufNumber=HC-155. Accessed
September 19, 2014.
16
American Dental Association. 2013 Survey of Dental Fees. Center for Professional Success. 2014. Available from:
https://success.ada.org/en/practice/operations/financial-management/2013-survey-of-dental-fees. Accessed October
13, 2015.
13
Research Brie
f
17
U.S Office of Personnel Management. Dental & Vision Plan Information. Available from:
https://www.opm.gov/healthcare-insurance/dental-vision/plan-information/. Accessed August 7, 2015.
18
Tekavec, C. Coding and considerations for crowns, veneers, inlays, onlays, and CAD/CAM restorations. Dental
Economics. Available from: http://www.dentaleconomics.com/articles/print/volume-98/issue-5/features/coding-and-
considerations-for-crowns-veneers-inlays-onlays-and-cad-cam-restorations.html. Accessed October 8, 2015.
19
Analysis available upon request. Conducted August 6, 2015.
20
Analysis available upon request. Conducted August 6, 2015.
21
Email communication with American Association of Pediatric Dentists. August 6, 2015.
22
A total of 47 codes were dropped from the patient profiles among children ages 1 through 6, 80 codes were dropped
from the patient profiles among children ages 7 through 12, and 93 codes were dropped form the patient profiles among
children ages 13 through 18.
Suggested Citation
Yarbrough C, Vujicic M, Aravamudhan K, Schwartz S, Grau B. An analysis of dental spending among children with
private dental benefits. Health Policy Institute Research Brief. American Dental Association. April 2016 (Revised).
Available from: http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_0316_3.pdf.