Table of Allowance

A table of allowance is a predetermined schedule of maximum dollar amounts that a dental insurance plan assigns to each CDT procedure code for the purpose of calculating reimbursement. The insurer bases its payment on the allowed amount rather than the dentist's actual submitted fee. When the dentist's fee exceeds the allowed amount, the plan pays its coinsurance percentage based on the lower allowed figure, and the disposition of the difference depends on whether the provider is in-network or out-of-network. Tables of allowance may also be called fee schedules, schedules of benefits, or maximum allowable charges, and they vary not only between carriers but between different plans offered by the same carrier.

For in-network providers, the table of allowance functions as the contractual fee ceiling. The dentist has agreed to accept the allowed amount as full payment for the service, writing off any difference between the practice fee and the allowed amount. The patient's responsibility is limited to their coinsurance share of the allowed amount, which provides cost predictability for the patient. For out-of-network providers, the table of allowance still determines the insurer's payment calculation, but the dentist is not bound by the allowed amount and may balance-bill the patient for the difference between the allowed amount and the full fee. This distinction is one of the most significant factors in patient out-of-pocket costs and is frequently misunderstood.

In day-to-day revenue cycle work, access to the table of allowance during benefit verification is essential for generating accurate patient cost estimates. When the billing team knows the plan's allowed amount for a specific procedure, the patient estimate can reflect the actual reimbursement calculation rather than a general projection based on coinsurance percentages alone. This precision matters most for major services where the gap between the practice fee and the allowed amount can be hundreds of dollars. Practices that incorporate allowance data into their treatment estimate workflow experience fewer patient billing disputes, stronger point-of-service collections, and more informed case acceptance conversations because the financial presentation is grounded in the specific plan's reimbursement structure.