Billing · Updated 2026-09-08 · 5 min read

Are fee schedule, allowed amount and contracted fee the same thing?

Three terms carriers use for three different objects: the list, the number applied to one claim line, and the price your contract sets.

They are three different objects and carriers use all three words. A fee schedule is a list: the maximum fee for each procedure under one network at one carrier. A contracted fee is a single price on that list — the number your office agreed to accept for one code under one network. An allowed amount is the number a payer actually applied to one claim line on one date, which is normally the lesser of the schedule fee and the fee you charged, and which therefore tells you the schedule only when your fee is higher. Across paid dental claim lines as of August 2026, 12.8% came back with no allowed amount printed on them at all, and 44.7% of paid lines carried no identifiable pricing basis.

What we measured

Paid dental claim lines and stored practice fee lists across the practices we serve, aggregated. The 18.5% figure is the one offices find most uncomfortable: nearly one price point in five that a practice has filed under a carrier's name is the same number it also filed under another carrier's name — which is why a list labelled "Delta fee schedule" in a practice management system is frequently not Delta's.

What the carriers' own documents say

On the fee schedule, as a list:

"Table of Allowances — a list of covered services with an assigned dollar amount that represents the total obligation of the plan with respect to payment for such service, but doesn't necessarily represent the dentist's full fee for that service."

— Delta Dental of New Jersey 2023 Participating Dentist Handbook, glossary.

On the allowed amount, as the result of a calculation rather than a lookup:

"Dentists who participate in Delta Dental PPO agree to accept the lesser of their actual fee, filed fee, or the applicable Delta Dental PPO Table of Allowances fee for Delta Dental PPO covered patients as payment in full."

— the same handbook, on how a PPO claim is priced. Delta's national processing policies give the result of that calculation its own name — the approved amount, "the total fee a participating dentist agrees to accept as payment in full for a procedure", including "both the Delta Dental allowance and the patient responsibility" — 2026 Delta Dental Dentist Handbook. That is the whole distinction: the schedule is a list, the approved amount is the smaller of that list's entry and your charge.

On the contracted fee, from a different carrier:

"Contracted fee: The fee to be charged for a service that Cigna Healthcare has negotiated with a contracted provider on your behalf."

"Actual billed charges: The fee that a provider charges a patient who does not have dental insurance for a service. If a patient has dental insurance and visits an Advantage provider, the provider charges the negotiated rate/contracted fee for covered services."

— Cigna Healthcare Dental Individual & Family Plan 3000/100 Schedule of Benefits, Total Network, 2025.

And a fourth word for the same list, at MetLife, where the fee schedule and the table of maximum allowable charges are one object:

"MetLife's Table of Maximum Allowable Charges or Fee Schedule applies to dental procedures performed on eligible members participating in MetLife's Preferred Dentist Program (PDP). The allowances represent the maximum amount you're contractually allowed to collect from the plan participant for dental services rendered (including all amounts reimbursed by MetLife). These allowances may also be referred to as the 'plan allowance.'"

— MetLife Preferred Dentist Program (PDP) Resource Manual, 2025.

A fifth: at Ameritas, "PPO MAC fees" is simply the name of the contracted office's own fee schedule, downloadable from the carrier's website — Ameritas Classic Network provider promotion guide. So "MAC" at one carrier names the in-network list, while at Delta it names a plan design. Read the document, not the acronym.

Why it depends on the plan

A carrier's fee schedule is not one list. As of August 2026, one Delta company published six separate schedules to a single contracted office — PPO and Premier crossed with general dentist, hygienist and specialist — and D0120 carried three different prices across them. On the same contract, the general-dentist schedule ran 727 codes, the hygienist schedule 87 and the Premier Specialist schedule 170.

Which of those lists prices a claim depends on the plan the patient's employer bought as much as on your contract. Delta lets an employer decide whether Premier dentists are reimbursed at Premier fees or at PPO fees, and on a MAC plan the PPO schedule prices every tier. Cigna's out-of-network reimbursement on its retail products is priced off "a basic Advantage fee schedule within a specified area" rather than a percentile.

What to do

• Keep three fields, not one, in your practice management system: your office fee, the contracted fee for that network, and the allowed amount a payer actually applied. Collapsing them is what produces confident wrong estimates.
• Load a fee schedule per network and per provider type, not per carrier. One carrier can hand you six lists.
• Ask the payer for the schedule by its name — "the PPO schedule of allowances", "the table of maximum allowable charges" — rather than for "your fees".
• Do not build a fee schedule from a handful of remittances. A single observation misses the stable answer by a median 16.5%, and half of the group-level cells Kaylie measured rest on exactly one observation.
• Check whether a list already in your system under one carrier's name is really that carrier's. 18.5% of practice price points are filed under more than one payer.

Numbers last refreshed August 2026.

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