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Dental insurance companies divide benefits, services, or procedures into categories and refer to them with American Dental Association (ADA) 3-4 digit code. As an example, Preventive and Diagnostic procedures often include exams (ADA code 0120), x-rays (ADA code 0210), and basic cleanings or prophylaxis (ADA code 1110).
For dentists, the American Dental Association defines a usual and customary fee as "the fee an individual dentist most frequently charges for a specific dental procedure independent of any contractual agreement. It is always appropriate to modify the fee based on the nature and severity of the condition being treated and by any medical or ...
Dental service organizations, known in the industry as dental support organizations [1] or abbreviated to DSOs, are independent business support centers that contract with dental practices in the United States. They provide business management and support to dental practices, including non-clinical operations. [2] [3]
This practice was known as sliding fees and became a legal rule in the 20th century in the U.S. [7] [10] Eventually, changing economic conditions and the introduction of health insurance in the mid-20th century ushered an end to the sliding scale. [11]
In 1980, an early PPO was organized in Denver at St. Luke's Medical Center at the suggestion of Samuel Jenkins, [3] an employee of the Segal Group who consulted with hospitals for Taft-Hartley trust funds. [4]: 6 By 1982, 40 plans were counted and by 1983 variations such as the exclusive provider organization had arisen. [3]
UnitedHealth Group, the largest Medicare Advantage provider with 7.6 million people in its plans, generated $257 billion in premium revenues in 2022, some 13% over the previous year.
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