For most of us, a trip to the dentist is a necessary evil (sorry dentists, you know how it is). But it's hard to know how big a bite your next visit will take out of your bank account, as fees vary a lot from practice to practice.
So we set out to find just how much dentist fees varied, getting quotes from 35 dental practices across Australia. We've also looked at the reasons why dentist prices are so inconsistent, and how you might be able to pay less for preventative dental care.
Unlike medical services covered by Medicare, which have prescribed fees, there are no standard fees for services provided by dentists or other dental professionals in Australia.
This means a patient can get 10 very different treatment plans from 10 different dentists – and each can charge as they please. Why?
Dentistry is regulated by the Australian Health Practitioner Regulation Agency (AHPRA) through the Dental Board of Australia (DBA), which provides registration standards, codes of conduct as well as guidelines for professional practice. These standards and guidelines only focus on ensuring quality of care and don't extend to pricing or prescribe a treatment method for each dental service.
Dentists' prices depend on a range of factors – such as location, overheads and differences in the method used (e.g. there are different ways to provide a filling) – according to the Australian Dental Association's (ADA) fee policy.
This means costs for the same procedure can vary because it may take longer to perform on some patients, or dentists might use different techniques, or the degree of difficulty could vary.
Variations in the treatment method and materials offered by clinicians for the same item numbers mean you won't necessarily want to choose your dentist based on cost alone, however it does help to have an idea of just how much other dental practitioners are charging for similar services.
To see just how much dental fees varied, we conducted a mystery shop by calling a total of 35 dental clinics across all eight states and territories (we included a mixture of capital city and regional dentists).
We enquired about the cost of a check-up – comprehensive oral exam (item number 011), scale and clean (114) and a fluoride treatment (121) – as a new patient without private health insurance. We also checked the price for two X-rays (022).
What we found: the cost of a check-up (oral exam/scale and clean/fluoride treatment) varied from $150 to $305, with an average price of $231. Need X-rays? Add another $89.50 for two, on average.
Results of CHOICE's mystery shop
- Cheapest: $150
- Most expensive: $305
- Average cost of a dental check-up: $231
Average cost of a check-up
Each year, the ADA surveys dental practitioners to provide average price data on over 100 dental treatments/item numbers.
According to the ADA's fee data, the average cost of the same check-up we mystery shopped – including the examination, scale and clean and a fluoride treatment – is around $222 (add an average of $90 for two X-rays).
The ADA fee survey also shows big price discrepancies for the cost of dental work across Australia. For example, prices for a tooth extraction (311) varied from $135 to $295, an anterior filling (521) from $115 to $206 and a crown (615) from $1261 to $1945. In terms of price, the ACT most often had the most expensive price, followed by Tasmania; and South Australia most often had the cheapest, followed by Western Australia.
You're also likely to pay more if you see a specialist as opposed to a general practitioner. Specialists, in addition to meeting all the minimum requirements of practising as a general dental practitioner, must have completed two years of general dentistry practice and hold a qualification in their specialist area. There are currently 13 different specialties in Australia: these include endodontics (root canal), orthodontics (such as braces) and prosthodontics (crowns and dentures) to name a few.
|Procedure (Item)||Average cost*||Range|
|Diagnostic and preventative|
|Comprehensive oral exam (011)||$66||$51–92|
|X-ray (per exposure) (022)||$45||$30–58|
|Scale and clean (removal of plaque and calculus) (114)||$118||$91–157|
|Fluoride treatment (121)||$38||$22–62|
|Fissure sealing (per tooth) (161)||$59||$40–86|
|Tooth extraction (311)||$185||$135–295|
|Preparation of root canal (chemo-mechanical) – one canal (415)||$278||$183–410|
|Preparation of root canal (chemo-mechanical) – one canal (416)||$136||$94–214|
|Filling – anterior tooth – 1 surface (521)||$153||$115–206|
|Filling – anterior tooth – 2 surfaces (522)||$182||$141–248|
|Filling – posterior tooth – 1 surface (531)||$163||$121–220|
|Filling – posterior tooth – 2 surfaces (532)||$202||$151–285|
|Full crown (veneered) – indirect (615)||$1558||$1261–1945|
|Denture (complete maxillary) (711)||$1298||$943–1990|
Table notes*Fees charged for the most common services provided by general dental practitioners (averages for specialists vary). Data based on the ADA's 2016 dental fee survey (not including the top or bottom 5% of prices).
So how does private health insurance fit into all of this? When it comes to dental costs and private health insurance, there are two elements you'll want to understand to choose a provider that offers you the best value for money.
- Rebates: This may be a percentage or fixed dollar benefit amount for each item number and is likely where you'll save the most money.
- Preferred provider networks: Using a fund's preferred provider may result in slightly lower fees, and higher rebates, but reduced choice.
To get value for money on your extras insurance you'll obviously need to make sure you're getting more back in benefits than you're paying in premiums, which is where rebates come in.
The average rebate available from private health insurers for a regular check-up – periodic exam (rather than the comprehensive exam included in our shadow shop), scale and clean plus fluoride – is $85. Though how much you get back will depend on your policy – some policies offer as much as 100% of the cost for a check-up.
For comparison, the average cost for the equivalent service, according to the ADA's fee data, would be $213. Dental rebates vary not only across funds, but also between policies within funds and for the service being claimed – and these variations can be significant. Some funds may offer more competitive rebates at preferred providers.
In addition to the rebates, you'll also want to check the annual limits for each category (e.g. there may be different upper limits for general and major dental work), as well as lifetime limits on particular services (e.g. orthodontic work).
While nearly all policies will provide rebates for preventative dental care such as check-ups (exam/scale and clean/fluoride), fewer policies are willing to fork out for more expensive work such as braces and crowns. For those policies that do cover major dental work, the premiums will generally be more expensive.
|Procedure||% benefits||$ benefits||$ benefits average|
|Dental exam – periodic (012)||50–100%||$14–100||$32|
|Scale and clean (114)||50–100%||$14–136.10||$62|
|Tooth extraction (322)||50–100%||$58–257.60||$120|
|Full crown (615)||50–100%||$225–1200||$672|
|Root canal therapy (417)||50–100%||$42–280||$144|
|Braces – upper and lower plus retainer (881)||50–100%||$300–2500||$774|
These figures are based on all policies that provide some level of cover for these services and excludes those that provide no cover for the service at all. These figures are based on extras policies for singles across Australia and are based on rebates available at any provider (not preferred providers). Per person figures may differ for couple, family and single parent policies and combined hospital and extras policies.
In addition to the rebates your policy offers that are available at any provider, using a dental practitioner in a preferred provider network may offer some additional benefits.
Some dental practices sign up to be part of a private health insurer's preferred provider network – some clinics are even owned by the fund – to attract clients. But in return for being listed as a fund's preferred provider, the private health insurer will set the price for services the dentist then supplies to the fund's clients. Prices set by the insurance fund for its clients are generally a bit lower than prices charged by a dental clinic to other consumers, but on average it's not a huge discount.
To give you an idea, for the equivalent check-up to the one we mystery shopped (an examination, scale and clean plus fluoride treatment), the average cost for those with private health insurance was $199.56 in 2015. That's around $22 less than the average fees charged by dental practitioners in the ADA survey (before taking into account any rebates).
Using a fund's preferred provider (note that not all funds have them) may save you some money in fees, however the flip side is you may have fewer dental practices to choose from. The ADA has been taking aim at private health insurers for the market power they're gaining through their preferred provider schemes. A generic letter from dentists as part of the ADA's campaign says that the growth of insurers' own clinics means "patients are being lured away from their long-term dentists, a development which disrupts the very valuable continuity of care that is integral to effective ongoing oral health care"
Using a preferred provider may save you some money in fees... the flip side is you may have fewer dental practices to choose from
Dr Hugo Sachs, president of the ADA, says that a preferred provider network doesn't necessarily infer a higher or lower quality of service, it's simply a commercial decision made by a clinic. However, given the need to discount fees through preferred provider schemes, he says it may result in the need for expediency by a dentist in order to achieve the same level of profit.
Higher rebates, preventative benefits
In addition to slightly lower negotiated costs at preferred providers, some funds may also offer a slightly higher rebate if you choose a preferred provider. It's also in a private health insurer's interests (and yours!) to fend off more expensive dental costs later down the track. As such, many private health insurers provide incentives in the form of free or low-cost preventative dental care. To reap the benefits of no-gap preventative dental care, some funds will require you to obtain it through one of their preferred providers.
While Australia's five largest funds (Bupa, HBF, HCF, Medibank and NIB) all have an extensive network of preferred providers, smaller funds often pay the same benefits for all dentists, or only have a handful of preferred providers or dental centres. Besides the funds we list below, other funds with a network of providers include AHM, Australian Unity, Defence Health, Peoplecare and TUH.
No of providers: Over 6000
Benefits at preferred providers: 60–100% back at preferred providers on most general and major dental treatments on some policies and 100% back for kids dental services on some policies.
No of providers: About 500 (WA only)
Benefits at preferred providers: 60–90% benefit back across general dental, major dental and orthodontics/implants depending on policy held; 100% back on one scale and clean per person, per year; 100% back for preventative dental for kids at preferred providers.
No of providers: Less than 6000
Benefits at preferred providers: 100% back on one or two check-ups, one or two scale and cleans and one fluoride treatment per person per year at preferred providers.
No of providers: About 10,000
Benefits at preferred providers: 100% back for kids on some policies and 100% back on check-up, clean and fluoride at least once a year on all extras/combined policies on top of annual limit for adults and children at preferred providers.
No of providers: Over 500
Benefits at preferred providers: 50–75% benefit back at all providers. 100% back for check-up, scale and clean at six NSW and one Melbourne NIB-branded Dental Care Centres.
While you ultimately have the right to choose whether to go ahead with a particular treatment plan or not, most of us don't have expertise in dentistry. This makes it hard to know whether a dental practitioner's recommendation is the best course of action or if they're trying to make a profit at your expense.
This is exacerbated by the fact that there are no national guidelines on treatment and diagnosis ensuring that you're being treated according to the evidence-based practices.
While the item number definitions contained in the ADA's Australian Schedule of Dental Services and Glossary help consumers compare prices, they don't ensure you can compare like for like services. That's because the item numbers refer to "a treatment outcome" rather than the clinical technique to achieve this, according to the Glossary.
And while the DBA's Code of Conduct highlights what good practice should be, it doesn't go as far as outlining the ideal treatment for particular conditions. It only states that a dental practitioner should provide "treatment options based on the best available information and not influenced by financial gain or incentives" and says that these options should be presented in a way that you understand and not be excessive or unnecessary.
According to Dr Hugo Sachs, president of the ADA, the absence of guidelines is because there are often various ways of treating a dental condition. For a patient presenting with a dental problem, "Ten different dentists will come up with 10 different ways to treat it," he argues. There are often pros and cons to each treatment, it's not necessarily that one is any better than the other, he adds.
However, Professor Hans Zoellner, head of oral pathology at the University of Sydney says the lack of national guidelines means there's no assurance for consumers that they're being treated according to current best practice.
The lack of national guidelines means there's no assurance for consumers that they're being treated... to current best practiceProf Hans Zoellner
Dentists must undertake 60 hours of continuing professional development every three years, but there are no core requirements for the training – only that it has a clinical/scientific basis.
The problem, according to Zoellner, is that guidelines for diagnosis and treatment change. For example, over the past 30 years, diagnosis and treatment for decay has improved greatly, he says. If the latest guidelines are applied properly with appropriate preventative therapy, "you can reduce the number of fillings that have to be done by about 30% [compared with 30 years ago]", he says.
These days, the recommendation for how often you need to take a trip to the dentist depends on your individual needs, though it's common for dental practices to encourage six-monthly check-ups. The six monthly recommendation is outdated, says Zoellner:
- The recommendation was questioned as far back as 1977.
- More recently a 2013 Cochrane review found there was insufficient evidence either "to support or refute the practice of six-monthly recalls".
- A review of evidence by the National Oral Health Promotion Clearing House found "no evidence that any particular interval between check-ups is more effective than another, or that six-monthly recalls are more appropriate than other longer intervals".
So do I still need to go every six months? The current national evidence-based recommendation for dental check-up frequency is that "everyone has different oral health needs and risk levels which should be reflected in the frequency of check-ups". The advice is to talk with your oral health professional about your risk level and how often you need to visit.
The absence of set prices for dental services makes it difficult to know if your dentist is overcharging. Unlike the Australian Medical Association, the ADA doesn't publish a recommended fee schedule, claiming that doing this would breach the Australian Competition and Consumer Act. Although price fixing is illegal, associations can provide recommended fee schedules – as long as they're not mandatory.
How much a dentist earns will depend on a range of factors such as whether they work in the private or public field, where they work and how many hours they work. For the minority of dental practitioners who charge by the hour, the average rate charged for service in 2016 was $435, according to the ADA's fee survey.
However, dentistry is also a costly business. According to the ATO, the total average expenses for a dental surgery range from 61-73% of the practice's total income.
Staff costs are the greatest cost for a dental practice, but clinic set-up costs, rent, consumables and annual registration fees and insurance are all extra costs involved in running a dentistry business.
Can I get subsidised dental treatment?
Many OECD countries have a range of national health schemes or compulsory social insurance funds that subsidise dental care and, in some cases, provide basic dental care for free. But in Australia, unless you're eligible for dentistry in the public system, it's the consumer who pays.
Of the $8.7bn spent on dental care in Australia in 2012/13, about 58% (or $5bn) came from out-of-pocket expenses paid by individuals. Private health insurance covers relatively little, with only 16% ($1.4bn) of dental expenditure coming from insurers, and the remainder being paid for by federal or state governments.
Dentistry is still unaffordable for many Australians. Research from AIHW in 2013 found that 35% of adults had avoided or delayed going to the dentist due to cost, a figure which has been on the rise since the 1990s. Public dental care is available to a limited segment of the Australian population, however waitlists can be significant.
Eligibility requirements for public dental care vary across states and territories but it is usually available to those with a healthcare or pensioner concession card. Children aged between two and 17 are eligible for free basic dental care such as check-ups, fillings, seals, extractions and root canal (up to the value of $1000) if their parent, carer or guardian receives the Family Tax Benefit Part A.
If you're looking for a new dentist, word of mouth is a good place to start.
- Ring ahead and get prices for a check-up, clean and fluoride treatment. How does this compare with the national average price of $222, as determined by the ADA's fee survey?
- A thorough examination should include an inspection of teeth, gums, inside of the cheek, palate, tongue and lips. A probe should be used to check gum pockets and a mirror for awkward spots. An average check-up takes 20–25 minutes.
- Don't let a dentist pressure you into having work done on the spot. If he or she recommends extensive work, get the item numbers of the proposed work so you can ring around for quotes.
- Be wary of accepting extensive and expensive treatment from a general dentist, unless you know their work well. This especially applies to complicated dentistry, such as orthodontics and prosthodontics.
Quality and care
Price is obviously a big factor, but it's not the only important thing. Other things to look out for in a dentist:
- Is the clinic clean and hygienic?
- Does the dentist have a good rapport with staff and patients?
- Do they clearly communicate any problems and possible treatment plans with you?
- Do they provide you with options and inform you of the risks involved?
- Do they answer your questions and provide you with reasons for their recommendations?
- Do they ensure that you agree to all fees and treatments before starting?
- Check your dentist is registered (and also if they are a specialist) on AHPRA's website.
Remember you have the right to ask questions about any recommended course of action. Don't be afraid to get a second opinion, either.
Try to resolve any issues with the practitioner first. Complaints about the health, performance or conduct of a registered dental professional should be made directly to AHPRA (except in NSW, and Queensland where all complaints go through the relevant health complaints entity (see below). This may include concerns over unsafe work practices, or behaviour that may place the public at risk.
If you think there are any other aspects of a service you received that were unreasonable, such as fees or the quality of care, complain to the health care commission in your state or territory.
- ACT: Health Services Commissioner within the ACT Human Rights Commission – 02 6205 2222
- NSW: Health Care Complaints Commission – 1800 043 159
- NT: Health & Community Services Complaints Commission – 1800 004 474
- Qld: Office of the Health Ombudsman –133 646
- SA: Health & Community Services Complaints Commissioner – 08 8226 8666 (Adelaide metro); 1800 232 007 (elsewhere)
- Tas: Health Complaints Commissioner – 1800 001 170
- Vic: Office of the Health Services Commissioner – 1300 582 113
- WA: Health and Disability Services Complaints Office – 08 6551 7600 (Perth metro); 1800 813 583 (elsewhere)
If you have a complaint about your private health insurer, you should try to resolve it with the insurer first. If that fails, you can direct it to the Private Health Insurance Ombudsman – 1300 362 072.