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How to Discuss Fees With Patients

How can I ascertain whether the fees for the procedures I am providing are appropriate? Ihave had patients ask me about the costs involved for specific treatments and I am not sure how to handle this.

Dentists can charge whatever they want for their services but standards do exist. A dental fee guide, which is typically updated annually, provides the most reasonable and customary rate for all dental codes. For example, the American Dental Association (ADA) publishes its Survey of Dental Fees, which provides information such as the national average fees broken down for both general practitioners and each of the six specialties, national level statistics for fees for more than 200 commonly performed dental procedures, average fees charged by general practitioners broken down into nine regional areas based on United States Census divisions, and dental procedures identified by procedure code and nomenclature from the Code on Dental Procedures and Nomenclature as published in the ADA’s most recent Current Dental Terminology.1 This publication is free for ADA members. 

Although the ADA’s Survey of Dental Fees is useful, its data are self-reported. Dental hygienists can refer to it when assessing whether their practice’s fees fall within the realm of the ADA’s fee schedule. Dental hygienists can also check with their peers regarding their practice’s fees, but not all dental practices are equal. The use of technology and  high-quality sterilization, hiring and retaining quality employees who command an income reflective of their scope of practice, provision of benefits, and maintaining a standard of care are all factors that contribute to the cost of delivering dental services. 

Some codes may have varying fees. For instance, fees billed under code D9450 (treatment planning/case evaluation) may vary widely due to additional time spent outside of the mouth to create an appropriate treatment plan and alternative treatment plans that consider a patient’s best interests. It takes time to collate all of the relevant information assessed, establish a dental and dental hygiene diagnosis, consider and formulate various treatment options, and, finally, consult with the patient, educating him or her on the causes and future prevention of the diagnosed dental problems using radiographs, photographs, diagnostic casts, and other information. The fee charged typically reflects the time taken to customize a treatment plan and discuss the plan with the patient.

When informing patients about charges for their treatment, dental offices should have financial responsibility policies that are reviewed and signed by patients. Additionally, while patients may have signed financial responsibility statements, informing them of the fees for the treatment planning appointment and what part of the fee may or may not be covered by insurance is ethically the right approach.

Dental hygienists can always initiate a conversation with the dentist employer regarding fees to avoid any misunderstandings. Communication and cooperation among the dental team are essential to providing high-quality services. Dental hygienists are key team members in the provision of dental care, play a crucial role in the health of their patients, and are integral to patient treatment acceptance and satisfaction.2 As such, engaging in productive conversations with the dentist and gaining an understanding of the office policies and procedures, fees, and patient responsibilities will create a better-quality office environment for the dentist, dental hygienist, and the patient. 


  1. American Dental Association. Survey of Dental Fees, 2020.  Available at: Accessed October 21, 2021.
  2. Hamasaki T, Kato H, Kumagai T, Hagihara A. Association between dentist-dental hygienist communication and dental treatment outcomes. Health Commun. 2017;32:288–297.
The Ask the Expert column features answers to your most pressing clinical questions provided by Dimensions of Dental Hygiene’s online panel of key opinion leaders, including: Jacqueline J. Freudenthal, RDH, MHE, on anesthesia; Nancy K. Mann, RDH, MSEd, on cultural competency; Claudia Turcotte, CDA, RDH, MSDH, MSOSH, on ergonomics; Van B. Haywood, DMD, and Erin S. Boyleston, RDH, MS, on esthetic dentistry; Michele Carr, RDH, MA, on ethics and risk management; Erin Relich, RDH, BSDH, MSA, on fluoride use; Kandis V. Garland, RDH, MS, on infection control; Mary Kaye Scaramucci, RDH, MS, on instrument sharpen­ing; Stacy A. Matsuda, RDH, BS, MS, on instrumentation; Karen Davis, RDH, BSDH, on insurance coding; Cynthia Stegeman, EdD, RDH, RD, LD, CDE, on nutrition; Olga A.C. Ibsen, RDH, MS, on oral pathology; Jessica Y. Lee, DDS, MPH, PhD, on pediatric dentistry; Timothy J. Hempton, DDS, on periodontal therapy; Ann Eshenaur Spolarich, RDH, PhD, on pharmacology; and Caren M. Barnes, RDH, MS, on polishing. Log on to to submit your question.

From Dimensions of Dental Hygiene. November 2021;19(11)46.

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