Billing · Updated 2026-09-08 · 6 min read

What is a maximum allowable charge (MAC) in dental insurance?

Five carriers define it in their own words — and they do not all mean the same thing by it.

A maximum allowable charge is the ceiling a plan will consider for a procedure, taken from a fixed schedule rather than from what dentists in the area charge. That much is common ground. What the acronym points at is not: at MetLife the table of maximum allowable charges is the in-network fee schedule; at Delta Dental "MAC plan" names a plan design that pays the PPO fee schedule to every provider tier; at Ameritas "PPO MAC fees" is simply what the carrier calls the contracted office's own schedule; and Blue Shield of California uses its in-network MAC schedule as the out-of-network allowance. Four carriers, one acronym, three different objects. As of August 2026, 12.8% of paid dental claim lines came back with no allowed amount printed on them at all — so the number is often not on the document either.

What we measured

Paid dental claim lines across the practices we serve, aggregated. Between the lines that print no allowance and the lines that print your own fee back, a large share of remittances carry no information about a payer's maximum allowable charge.

What the carriers' own documents say

MetLife — the fee schedule and the table of maximum allowable charges are one document:

"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)."

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

Delta Dental — MAC is a plan feature, and it moves the ceiling for every tier:

"If the network for your dental plan selection is MAC PPO: Payment for a PPO dentist is based on the PPO dentist's allowable fee or the submitted fee charges, whichever is less… Payment for a Premier dentist is based on the PPO dentist's allowable fee. Members are responsible for the difference between the Premier Maximum Reimbursable Amount (MRA) and the PPO fee."

— Delta Dental of Arizona Flex Choice Group Plan Benefit Highlight Sheet, form DDAZ-0532-rev0825, 2025.

Cigna — the word used is "contracted fee", and on its retail plans Cigna prices out-of-network care off a basic Advantage fee schedule in the area — a schedule, not a percentile:

"Contracted fee: The fee to be charged for a service that Cigna Healthcare has negotiated with a contracted provider on your behalf. The most Cigna Healthcare will pay a dentist for a covered service or procedure for out-of-network dental care is based on a basic Advantage fee schedule within a specified area."

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

TRICARE Dental Program, administered by United Concordia — a federal programme with no percentile in it anywhere:

"Reimbursement is based on United Concordia's DoD Programs Schedule of Maximum Allowable Charges (MAC)."

— TRICARE Dental Program provider Fast Facts, 2023. The programme's patient-facing brochure states the exposure in the plainest words any carrier uses:

"If you see a non-network dentist: Non-network dentists haven't agreed to use the TDP rules and costs for care. You may be billed the full cost for your care. You pay the cost-share plus the difference between the TDP's maximum allowance and what the dentist charges."

— TRICARE Dental Program brochure.

BCBS FEP Dental — the in-network protection stated as an absolute:

"For in-network dentists, based on our contracted dental rates. The member is not responsible for billed amounts that are more than the plan allowance. For out-of-network dentists, based on the out-of-network plan allowance. FAIR Health (a non-profit, non-insurance operation) data is utilized to determine the out-of-network plan allowance."

— 2026 BCBS FEP Dental official brochure, OPM FEDVIP.

And United Concordia's commercial passive PPO shows why the acronym matters more than the coverage percentage: the coinsurance is the same in and out of network, and the member pays the difference between the dentist's submitted fee and the maximum allowable charge when the dentist does not participate. "80% either way" is not the same benefit either way; the whole difference is the schedule.

Why it depends on the plan

Whether a maximum allowable charge protects your patient or exposes them is decided by the plan, not by the acronym:

• In network, the MAC is a ceiling on what you may collect and the patient owes nothing above it. MetLife: "The participant is not responsible for any amount that exceeds the plan allowance."
• Out of network, the MAC is a ceiling on what the plan pays and the patient owes everything above it. TRICARE's brochure and Cigna's balance-billing definition both say so directly.
• On a Delta Dental PPO MAC plan, a contracted Premier dentist is paid from the lower of the two allowances on a patient they are contracted with, and the member is responsible for the difference up to the Premier allowance.
• Guardian sells a product called DentalGuard Preferred PPO MAC, describing it as combining "the freedom of a PPO dental plan with the economy of managed care" — so "PPO MAC" is a product name at more than one carrier.

What to do

• When a payer says MAC, ask what it is the maximum of: the in-network schedule, the out-of-network allowance, or both. On some products it is the same table doing both jobs.
• Ask whether the patient may be billed above it. In network the answer is normally no; out of network it is normally yes, and that gap is the number your estimate lives or dies on.
• Do not read a coverage percentage as a benefit level. A passive PPO pays the same percentage out of network of a much smaller allowance.
• Record the allowance per network, per code, dated. A maximum allowable charge is a contracted number that changes when the schedule changes, not a permanent fact.
• Where the remittance prints no allowed amount, record it as unknown. It is 12.8% of paid lines, and treating a blank as zero or as full payment corrupts the next estimate.

Numbers last refreshed August 2026.

All articles · Kaylie