As PPO reimbursements continue to stagnate — or decline — many dentists are asking the hard questions:

"Is there a connection between the number of dentists who are in-network in a given area… and the poor fees we’re being paid?"

It’s a smart question — and one that gets to the heart of how supply, demand, and provider participation shape the dental insurance landscape. In this article, we’ll explore:

• The current percentage of dentists who are in-network, nationwide and by state

• Whether high in-network saturation contributes to lower reimbursements

• What this means for your own decision to stay in-network or drop low-paying plans

What’s the True In-Network Participation Rate Among Dentists?

As of the most recent data (ADA Health Policy Institute, 2023):

• About 74% of general dentists in the U.S. participate in at least one PPO dental plan

• Around 60% of all dentists (general + specialists) are contracted with multiple PPOs

• Only 20–25% of dentists identify as fully fee-for-service (FFS) or “insurance-free”

• Pediatric dentists and oral surgeons tend to participate in PPOs at lower rates than general dentists

State-by-State Variability: Are Some States More In-Network Than Others?

Yes. In-network participation varies significantly by state and region, often based on:

• Population density

• Competitive landscape

• Patient demographics (insurance-dependent vs. affluent communities)

• Medicaid expansion (some states with high Medicaid enrollment see higher PPO participation due to lower FFS demand)

Examples (estimates based on ADA HPI + regional data):

• California (75–80%)

  • High PPO competition

  • Urban saturation

• Texas (70–75%)

  • Large PPO presence

  • Corporate group penetration

• Florida (70–80%)

  • High retiree population

  • Medicare Advantage dental riders

• New York (60–65%)

  • Mix of PPO and Fee-for-Service (FFS)

  • Some regional FFS strongholds

• Colorado (55–60%)

  • Growing FFS trend

  • Particularly in suburban areas

• Massachusetts (60–70%)

  • Strong Delta Dental influence

• Arizona (65–70%)

  • Mix of Dental Support Organizations (DSOs) and independent practices

• Utah (50–60%)

  • Notable trend of private practices dropping PPOs

• Washington (55–65%)

  • Delta Dental policies under scrutiny

  • Growing FFS movement

• North Dakota (80–85%)

  • Fewer alternatives to PPO participation

Does Higher In-Network Participation Correlate with Lower PPO Fees?

Yes, in many cases. The basic economics are clear:

• The more providers in-network, the more leverage insurance companies have to keep fees low.

• In markets with high saturation, insurers don’t need to negotiate higher reimbursements because access is abundant.

• Conversely, in areas with fewer in-network providers, insurers may offer higher fees or incentives to maintain network adequacy and avoid patient complaints.

In short: the more dentists who say “yes” to low fees, the longer those low fees stick around.

Key Insight: Networks are Built on Participation, Not Necessity

Unlike medical plans (which often need hospitals and specialists to participate for adequacy), dental networks are voluntary and built on volume. Insurance companies don't have to increase reimbursement — unless:

• Patients are complaining about lack of access

• Too many providers leave, forcing them to renegotiate fees

• States pass legislation to support non-covered service laws or prompt-pay regulations

This means dentist behavior directly shapes insurance leverage.

Why This Matters to You

If you’re practicing in a high in-network area where fees are unsustainable, you’re likely:

• Working more to earn less

• Spending more time on admin and denials

• Facing burnout from high-volume, low-margin care

Dropping even one or two low-paying PPOs can:

• Increase your average reimbursement per patient

• Allow more time for quality care

• Shift your practice toward long-term sustainability

Final Thoughts: Your Participation Shapes the Market

Yes, the trend of dentists staying in-network — especially in saturated states — is real. And yes, it’s contributing to the downward pressure on PPO reimbursements.

But the tide is slowly turning.

More dentists are:

• Terminating the worst-performing plans

• Educating patients on out-of-network benefits

• Offering in-house membership plans

• Rebuilding their schedules around profitable, value-driven care

You don’t need to go fully FFS overnight. But being strategic about which PPOs you participate in — and how they align with your business goals — is one of the most impactful decisions you can make.

Benjamin Tuinei

Founder - Veritas Dental Resources, LLC
Phone: 888-808-4513

Services:
PPO Fee Negotiators | PPO Fee Negotiating | Insurance Fee Negotiating
Insurance Credentialing | Insurance Verifications

Websites:
www.VeritasDentalResources.com | www.VerusDental.com