Table of Allowances (Insurance)

A table of allowances is a predefined list of dental procedures and the corresponding maximum dollar amounts that a dental benefit plan will pay for each service. This schedule serves as the foundation for how claims are reimbursed under the plan. Each procedure, typically identified by its CDT code, is assigned a specific dollar amount that represents the plan's payment ceiling for that service. The table of allowances may also be referred to as a schedule of allowances, fee schedule, or maximum allowable charge, depending on the payer and plan type.

Dental plans use tables of allowances in different ways depending on the plan design. In a table of allowances plan, the listed amount is the total benefit the plan will pay, and the patient is responsible for any difference between the allowance and the dentist's actual charge. This differs from a usual, customary, and reasonable (UCR) plan, where reimbursement is based on percentages of prevailing fees in a geographic area. It also differs from a contracted fee schedule plan, where in-network providers agree to accept specific negotiated rates. Understanding which reimbursement model a plan uses is essential for dental billing staff to accurately calculate patient portions and prepare treatment estimates.

For revenue cycle teams, the table of allowances has a direct impact on practice collections and profitability. Practices should compare their office fee schedule against each payer's table of allowances to identify procedures where the gap between the submitted fee and the allowed amount is significant. Large discrepancies may indicate that participation in a particular plan is not financially viable, or that patient financial presentations need to clearly communicate expected out-of-pocket costs. Regular review of payer allowance tables, especially when contracts are renewed, helps practices make informed decisions about network participation and fee schedule adjustments.