Dental Procedure Comparison Chart

Production / Collection:

A lot of doctors confuse production with collection. They are not the same. Collectible production is hard. 

The mistake some doctors make is that they only think of the money as something that’s easy if they do big dollar procedures. What they should think of is that it's a hurdle. It's a negative when you are trying to make it.

The mistake many dentists make is thinking that higher priced procedures will bring them more money. What they do not realize is that for patients, price is a hurdle, price is an ugly word. So, when doctors go about getting extra certifications to do the high dollar procedures, especially the ones that insurance does not cover, they are actually raising the hurdle for themselves in getting patients to commit to spending their hard earned dollars at their office. Lower price procedures are easier to sell, faster to complete, and easier to collect on. 

 GP dental procedures are analyzed in the chart below. The procedure with the lowest overall score has the least hurdles from production to collection, therefore is the easiest to collect. See the chart below. Assuming the patient has PPO. Procedures not paid by PPO are not listed. Price per procedure is not part of chart below

0 = No Required / Low / Never  

0.5 = in between / Sometimes

1 = Required / High

I. Filling:

Advantage:

1. Most insurance pays 80% therefore case acceptance is very high because out of pocket cost is extremely low!
2. Low fee for patients. Patients will gladly pay even if there is no insurance since the fee is so low!

   3. Opportunity is very extremely high!!!!

   4. Cost to produce it is very low!

   5. Time to finish is very very short!

   6. NO LEARNING CURVE!

   7. Waiting period usually does not apply to fillings

   8. Collect immediately after procedure is finished

   9. Insurance always pays. In my 25 years there was not a single time insurance did not pay.

  10. Replacement period is usually 1 year

  11. Anesthetic often not needed

  12. No x ray of any kind needed

  13. No risk to license at all since procedure is so easy

  14. Prerequisite is never needed

Disadvantages:

1. Low fee

2. The only disadvantage factor is also the precise reason that some dentists consider fillings as junk. So unfortunate!

II. RCT 

Advantage:

1. Most insurance pays 80% therefor case acceptance is high

2. High fee for dentist 

3. Low fee for patients. 80%

4. Cost to produce it is very low

5. Opportunity is very high

6.  Patient will pay for it because pain regardless price

7. Time to finish even a molar can be very low. See doctor Kim x-rays

8. Waiting period usually does not apply to RCT

9. Collect immediately after procedure is finished

10. Insurance always pay

11. Replacement period is usually 1 year

14. Prerequisite is never needed

Disadvantages:

1. High learning curve. But once you clean it you will love it. 

2. Very painful therefor anesthetic is always needed

3. Pre and Post op x-ray always needed

4. Slight risk to license

III. SCRP 

Advantage:

1. High fee for dentist

2. Low fee for patients. 80%

3. Low learning curve

4. Can send claim right after procedure is finished

5. Opportunity is very high

6. No risk to license

Disadvantage:

1. Very time consuming.  Time consuming because not only does the dentist have to numb and clean every single tooth but pocket depth for 6 surfaces of each tooth will need to be probed and recorded.

2. Well taken pano is always needed

3. Bloody

4. Often not paid. It's the hardest procedure to collect

5. Very painful and most hated procedure by a patient. It’s the most painful in dentistry therefore every single tooth would need to be numbed before the procedure starts. 

IV. EXT 

Advantage:

1. Low fee for patient therefor case acceptance is high
2. Patient will pay for it because pain regardless price
3. Waiting period almost never apply to simple extractions
4. Simple extraction never has waiting period
5. Prerequisite is never needed

Disadvantages:

1. High learning curve 
2. Very painful therefor anesthetic is always needed
3. Pano that's well taken is always needed
4. Low fee for dentist
5. Waiting period often apply to surgical, soft tissue, partial bony and full bony
6. Bloody
7. Some risk to license

V. Prosthodontics:

Advantage:

1. High fee for dentist 

Disadvantages:

1. High learning curve
2. Remake happens often
3. Opportunity is very low
4. Anesthetic is always needed
5. Take 2 - 4 appointments. If a patient does not show at any of the 3 remaining appointments then all the time spent, all material used will be wasted with no collection since most prosthodontic procedures are paid on delivery. Therefore it’s harder to collect
6. High fee for patients therefore case acceptance is much lower due to high fee and low insurance coverage. Insurance companies only pay 50% of these procedures therefore out of pocket is very high.
7. Often there is also a waiting period which can be as long as 1 year. 
8. Replacement period is usually 5 year.
9. Cost to produce it is very high
10. Procedure is very time consuming
11. Pre and Post op x-ray always needed
12.  Some risk to license
13. Prerequisite is sometimes needed

Fillings & veneer comparison and other high dollar dental procedures. 

Cost comparison for composite filling and veneer

Veneer is for pure aesthetics however it costs so much, as a result most patients cannot pay thousands of dollars for each veneer. On the other hand they can afford to pay for composite fillings. It costs much less and is often covered by insurance at 80%. As a result, acceptance of filling is much higher than veneer. Case acceptance is high because it's much easier for patients to afford a $200 filling than a $2000 veneers. More importantly most insurance companies will pay 80% of the $200 which means the patient out of pocket cost would only be $40. Out of pocket for veneer could be as much as $2000 each because insurance never covers it.

Stories:

When told about composite fillings Dr P commented that he would much rather put in amalgam even today if he could get his hands on any rather than putting in composite regardless of the negative aspects of amalgam. It’s true, it’s just his opinion. I should not have feelings toward remarks like this. I looked across the small Starbucks table and saw a doctor who graduated from USC, who could do implants all day, yet he was let go from a night job. He was looking for a way to work seven days a week. I could only guess that it was because he was not making enough yet he was still not open to doing things any other way. I felt sad for him and all the other dentists like him that I’ve interviewed over the years. They would rather work like that for the rest of their lives rather than to let go of the myth that high dollar procedures will make them rich. For a lucky few it does, for the ones who I have met, it definitely has not. And the people I feel the most sad for are all their patients whose needs are inevitably not being addressed and may never be taken care of until they end up in an office like mine and their teeth at that point are not savable.

What's the real reason many dentists fight composite filling and call it junk?   Money, of course. As with many doctors, my conversation with  Dr. P went the same way. Implants make so much more money, fillings are just junk. Therefore, if he could do fillings that were even cheaper, as in the case of amalgams, he would place amalgams all day long.  It’s sad that a professional would think this way, but it's always true that profit is the main concern. Even sadder, these doctors do not understand that profit margins on implants are not nearly as high as fillings even if they can find a patient who can afford it and let a GP perform it.  

 If an implant is $6000 and their profit margin is 50%, all they can think about is that $3000. They are unable to consider anything else. They do not understand that once they get certified to perform implants, this does not automatically signify a steady stream of patients willing to pay for implants or let a GP place an implant for them. They also do not understand that $6000 is a very high entry price. Just like ferrari, very few people can afford it. 

 They do not think about why their malpractice insurance asks every year if they perform implants and approximately how much of their practice is focused on implants and why as a result, their insurance premium goes up as a result. They do not think about the specialized staff that they will have to hire, train, and retain, the special equipment that they will need to purchase, implant system, x-ray system, and supplies. Unless they are the business owner, they may not think about the cooperation and patient compliance required to complete the case and realize that profit. 

I used to think exactly like these doctors. I did it all. I only wanted to do the high dollar procedures. I pushed myself to become proficient in all aspects of general dentistry. I performed veneers, tori removal, horizontally impacted 3rd molar extractions, implants, braces, and more. But after my stroke I analyzed my dental career and asked myself, “What can a new dentist do to be less stressed and still make a great living? 

I thought about the doctors whom I knew who had awesome hand skills, but did not do well in their own personal practices. That's when I realized why I had seen so many four and five year olds with almost no teeth left. Many doctors look down on fillings. Many tell parents that the small caries on their child’s teeth will get better on their own. They tell patients with amalgam, however unaesthetic, that  it looks fine. Why? The same reason the dental director told me and the office manager on the first day to, “Let him do all the emergencies, exams, and fillings.” And to leave all the crowns, root canals, and real production to her. She wanted all the high dollar procedures and looked down on fillings of all kinds. Guess what? Not only did I produce more than her by the end of the day, she had her own business twice and failed both times.

This is the reason why many doctors struggle. I know several doctors who had phenomenal hand skills and were lightning fast, but when they tried to set up their own practices, they struggled and went under. One had the ability to extract all kinds of impacted teeth. One had the ability to do amazing root canals. Why did they fail? One common thread is that they felt that fillings were not worth their time. My advice for new dentists, relatively new dentists, and those with awesome hand skills, ignoring basic dentistry, which is fillings, is the cause of why dental businesses struggle. When doctors use the most basic procedure they learned in dental school, which is, using the tip of their explorer to see what sticks, it’s a win-win for both doctor and patient. 

In the real world, cavities never get better. Take care of it when it's small to prevent root canals, extractions, and 4 year olds with no teeth left. Fillings of all kinds are a win-win. Not doing them, only wanting to do high dollar procedures is a lose-lose. What made me successful and what made me able to collect over two million in a year as the solo practitioner at my first office is that I understand the concept that if one dollar coffee makes more money for MCD than all the exotic car sales put together, then at $100 per filling, we should all be doing very well. Of course, it can also change a patient's life for the better when they walk into your office with a mouth full of dark stained amalgams and leave with all tooth colored teeth. It’s remarkably transformative and that’s the primary goal. Please make sure you are also able to perform all other aspects of general dentistry so that if there are no fillings you can still make great production.

Conclusion: The secret to being a high producing dentist is to  know what to select as your core production while developing the skills to do high dollar procedures. 

In my opinion, the best way to achieve the highest profitability as dentists is following:

1. Do as many filings as needed. It's a win-win for both patients and providers. Make fillings the bulk of your daily production.

2. All other non filing procedures:

a. DDS shouldn’t depend on these procedures as the bulk of one’s daily production. On the contrary, these procedures should only be used to supplement fillings. 

b. Dentists should have the skill and speed to produce from these procedures on the days when fillings are not present as the bulk of production

c. Even though the learning curve is high for these procedures, dentists should not back down from them. Yes you will make mistakes while you learn them. The only dentist who does not make mistakes is one who never tried in the first place.  

d. Non GP procedure is not needed to be financially successful.