What does my dental contract mean when it refers to the number of “Scaling Units” allowed?

Aug 13, 2013

Have you ever looked at the claim form completed by the dentist and noticed that numeric codes almost outnumber words? Dental codes are a language in which insurance companies and dentists communicate. In an age where electronic dental interchange (EDI) is the norm for processing claims, the units and codes are how the insurance companies manage the dental service and reimbursement of those services.  Frequent procedure and claims that are often discussed and seen in contracts is  ” scaling units”. Scaling is one of the most common dental procedures performed. Scaling is basically the process of removing dental tartar from the surfaces of the tooth.

An invoice from a dentist may indicate that a patient has had one unit (or two, or three) of dental scaling. The term “Unit” is slightly misleading as it seems to indicate a specific quantity of plaque removal when in fact it does not. Often insurance companies determine the quantity and quality of treatments required for dental health. In doing so, terms are assigned. “Unit” is a term that measures quantity of service, not quantity of plaque removal. One unit of scaling equals 15 minutes. If you have had  dental benefits coverage for years, you may have noticed the allotment for scaling units has changed over time.

When dental plans were first designed, periodontal scaling was a surgical procedure performed by a dentist (general practitioner) or periodontist (specialist).  Scaling represented such a small portion of dental claims that it never got much attention.  However, that was until claims began increasing, at a very significant rate of 30-60% per year. The impact of scaling was not the only reason for the change in scaling unit allotment, but as dental hygiene in developed countries has also improved considerably over the years. And as such, the industry has seen scaling unit allotment change within insurance benefit programs. A combination of cost control and the historical improved dental hygiene have lead plan sponsors and insurers to reduce the units of scaling gradually over time by limited scaling to 16 units of 15 minutes (4 hours) per year, then 12 units (3 hours), then 8 units (2 hours) and more recently 6 units (1.5 hours). For the consumer, It is not only important that the dentist be aware of the scaling unit allotment, but that as the consumer of benefits, you are aware of what procedures were completed and the billing implication.

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