10-D10 - City of Burleson 906435 - ODSCR-01A - Dental Dashboard - Service 24Mo thru 2025-11.xlsx
XLSX spreadsheet 495 KB Posted
- Attached to
- RFP 2026-015 Dental & Vision Insurance Benefits
- Solicitation number
- RFP 2026-015
- Issued by
- Johnson County, Texas
About this file
This is a dental claims data dashboard report for the City of Burleson, Texas, documenting dental insurance utilization and cost analysis for a preferred provider organization (PPO) plan covering the service period of December 1, 2023, through November 30, 2025. The report analyzes claims data for Group ID 1019974 under Policy Number 0906435, with an effective date of January 1, 2016. The plan covers all eligible full-time employees, retirees, and dependents of the City of Burleson. The data reflects 649 accessing members across 21,509 member months, generating a total claim cost of $572,393 with an average per-member-per-month (PMPM) cost of $27.
The claims analysis reveals total submitted charges of $1,353,535, with network discounts of $320,172 (40.66% of in-network submitted charges) and an effective discount of 31.80% across all submitted charges. In-network claims represent 67.24% of total paid claims at $384,871, while out-of-network claims comprise 32.76% at $187,521. The covered amount totaled $727,517 after deductibles ($21,872), coinsurance ($129,058), and coordination of benefits adjustments. Top service categories include diagnostic services (21.67% of in-network paid claims) and preventive services (13.51% of in-network paid claims), with the most frequently utilized procedures being periodic oral evaluations, radiographic imaging, and adult prophylaxis. Member cost distribution shows 70.28% of accessing members incurred costs between $0 and $1,000 during the 24-month period, while 29.72% exceeded $1,000 in dental claims.
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Sheet1
CITY OF BURLESON
&"Arial,Regular"&5&F &"-,Regular"12/8/2025 4:30:53 PM
Sheet2
Group ID: 1019974
| Group Effective Date: 1/1/2016 | |
| Claim Cost Components |
Group Renewal Month Day: 01/01
Group Policy Number: 0906435
| CITY OF BURLESON | |
| Business Category: PPO |
Service Date Range: 12/1/2023 to 11/30/2025
Product ID: *
Accessing Member
| (Distinct Count) | Claim Cost | |||
| Total | Claim Cost Per | |||
| Accessing Member | Member Month | |||
| Total | Member Month | |||
| Average | Cost | |||
| PMPM | Accessing Member/ |
Member Month Average 649 $572,393 $882 21,509 896 $27 72.43%
Claim Cost Components In Network Out of Network Total
| Submitted Charges | $1,016,286 | $337,249 | $1,353,535 |
| Network Discounts | $320,172 | $0 | $320,172 |
| Ineligible Charges | $202,867 | $102,978 | $305,846 |
| Covered Amount | $493,247 | $234,270 | $727,517 |
| Plan Savings: | $108,376 | $46,749 | $155,125 |
| Deductibles | $17,172 | $4,700 | $21,872 |
| Coinsurance | $87,545 | $41,513 | $129,058 |
| Coordination of Benefits | -$3,659 | -$536 | -$4,195 |
| Overrides | $0 | $0 | $0 |
| Net Paid | $384,871 | $187,521 | $572,393 |
| Network Discount is 40.66% of In Network Submitted Charges minus Ineligible Charges and excludes Orthodontia. |
| Effective Discount is 31.80% of Total Submitted Charges minus Ineligible Charges and excludes Orthodontia. |
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Sheet3
Group ID: 1019974
| Group Effective Date: 1/1/2016 | |
| Claim Cost Components by Procedure Category |
Group Renewal Month Day: 01/01
Group Policy Number: 0906435
| CITY OF BURLESON | |
| Business Category: PPO |
Service Date Range: 12/1/2023 to 11/30/2025
Product ID: *
| In Network | Procedure Category | Submitted Charge | Allowed Amount | Network Discount | Ineligible Charge | Plan Savings | Total Paid | Total Paid % |
| Adjunctive General Services | $43,034 | $14,067 | $11,637 | $17,330 | $4,141 | $9,926 | 1.73% | |
| Diagnostic | $245,369 | $125,320 | $84,143 | $35,906 | $1,301 | $124,019 | 21.67% | |
| Endodontics | $52,691 | $34,261 | $13,606 | $4,824 | $9,034 | $25,227 | 4.41% | |
| Implant Services | $31,734 | $17,754 | $1,179 | $12,801 | $8,927 | $8,827 | 1.54% | |
| Major Restorative | $149,552 | $59,546 | $43,641 | $46,365 | $29,404 | $30,142 | 5.27% | |
| Minor Restorative | $133,175 | $67,475 | $64,473 | $1,228 | $18,786 | $48,689 | 8.51% | |
| Oral Surgery | $62,775 | $23,521 | $16,641 | $22,613 | $6,041 | $17,480 | 3.05% | |
| Orthodontics | $30,424 | $25,891 | $0 | $4,533 | $12,946 | $12,945 | 2.26% | |
| Periodontics | $93,063 | $35,720 | $36,761 | $20,581 | $11,274 | $24,446 | 4.27% | |
| Preventive | $130,429 | $77,741 | $37,160 | $15,527 | $425 | $77,316 | 13.51% | |
| Prosthodontics, Fixed | $26,463 | $4,809 | $4,999 | $16,655 | $2,430 | $2,380 | 0.42% | |
| Prosthodontics, Removable | $17,222 | $7,142 | $5,932 | $4,148 | $3,668 | $3,475 | 0.61% | |
| Sleep Apnea Services | $355 | $0 | $0 | $355 | $0 | $0 | 0.00% | |
| Sub Total | $1,016,286 | $493,247 | $320,172 | $202,867 | $108,376 | $384,871 | 67.24% | |
| Out of Network | Procedure Category | Submitted Charge | Allowed Amount | Network Discount | Ineligible Charge | Plan Savings | Total Paid | Total Paid % |
| Adjunctive General Services | $17,096 | $7,900 | $0 | $9,196 | $2,181 | $5,719 | 1.00% | |
| Diagnostic | $65,872 | $58,070 | $0 | $7,802 | $81 | $57,989 | 10.13% | |
| Endodontics | $11,378 | $9,122 | $0 | $2,256 | $1,824 | $7,297 | 1.27% | |
| Implant Services | $42,354 | $16,623 | $0 | $25,731 | $8,387 | $8,237 | 1.44% | |
| Major Restorative | $50,259 | $21,859 | $0 | $28,400 | $10,778 | $11,081 | 1.94% | |
| Maxillofacial Prosthetics | $276 | $0 | $0 | $276 | $0 | $0 | 0.00% | |
| Minor Restorative | $26,981 | $24,932 | $0 | $2,049 | $6,200 | $18,732 | 3.27% | |
| Oral Surgery | $33,778 | $24,830 | $0 | $8,948 | $5,621 | $19,209 | 3.36% | |
| Orthodontics | $17,990 | $15,013 | $0 | $2,977 | $7,506 | $7,506 | 1.31% | |
| Periodontics | $17,935 | $12,822 | $0 | $5,113 | $3,715 | $9,107 | 1.59% | |
| Preventive | $47,331 | $42,287 | $0 | $5,044 | $50 | $42,237 | 7.38% | |
| Prosthodontics, Fixed | $4,000 | $812 | $0 | $3,188 | $406 | $406 | 0.07% | |
| Prosthodontics, Removable | $1,998 | $0 | $0 | $1,998 | $0 | $0 | 0.00% | |
| Sub Total | $337,249 | $234,270 | $0 | $102,978 | $46,749 | $187,521 | 32.76% | |
| Total | $1,353,535 | $727,517 | $320,172 | $305,846 | $155,125 | $572,393 | 100% |
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Sheet4
Group ID: 1019974
| Group Effective Date: 1/1/2016 | |
| Top 10 Procedures by Network Summary |
Group Renewal Month Day: 01/01
Group Policy Number: 0906435
| CITY OF BURLESON | |
| Business Category: PPO |
Service Date Range: 12/1/2023 to 11/30/2025
Product ID: *
&"-,Regular"12/8/2025 4:30:53 PM
Sheet5
Group ID: 1019974
| Group Effective Date: 1/1/2016 | |
| Top 10 Procedures by Network Detail |
Group Renewal Month Day: 01/01
Group Policy Number: 0906435
| CITY OF BURLESON | |
| Business Category: PPO |
Service Date Range: 12/1/2023 to 11/30/2025
Product ID: *
| In Network | Procedure | Procedure Category | Submitted Count | Paid Count | Submitted Amount | Paid Amount | Submitted Average | Paid Average | Total Paid % |
| D0120 - periodic oral evaluation - established patient | Diagnostic | 753 | 739 | $48,593 | $30,102 | $65 | $41 | 5.3% | |
| D0230 - intraoral - periapical each additional radiographic image | Diagnostic | 816 | 773 | $23,344 | $13,032 | $29 | $17 | 2.3% | |
| D1110 - prophylaxis - adult | Preventive | 658 | 641 | $74,250 | $50,186 | $113 | $78 | 8.8% | |
| D0220 - intraoral - periapical first radiographic image | Diagnostic | 596 | 566 | $21,634 | $12,465 | $36 | $22 | 2.2% | |
| D0274 - bitewings - four radiographic images | Diagnostic | 463 | 451 | $36,876 | $22,549 | $80 | $50 | 3.9% | |
| D1206 - topical application of fluoride varnish | Preventive | 413 | 223 | $21,828 | $8,221 | $53 | $37 | 1.4% | |
| D1120 - prophylaxis - child | Preventive | 232 | 230 | $19,526 | $12,610 | $84 | $55 | 2.2% | |
| D8670 - periodic orthodontic treatment visit | Orthodontics | 160 | 146 | $24,788 | $10,554 | $155 | $72 | 1.8% | |
| D2150 - amalgam - two surfaces, primary or permanent | Restorative | 187 | 185 | $53,169 | $17,893 | $284 | $97 | 3.1% | |
| D0150 - comprehensive oral evaluation - new or established patient | Diagnostic | 173 | 167 | $18,998 | $11,187 | $110 | $67 | 2.0% | |
| Remaining Procedure Codes | 2,595 | 1,749 | $673,281 | $196,073 | $259 | $112 | 34.3% | ||
| Sub Total | 7,046 | 5,870 | $1,016,286 | $384,871 | $144 | $66 | 67.2% | ||
| Out of Network | Procedure | Procedure Category | Submitted Count | Paid Count | Submitted Amount | Paid Amount | Submitted Average | Paid Average | Total Paid % |
| D0120 - periodic oral evaluation - established patient | Diagnostic | 301 | 293 | $20,258 | $19,456 | $67 | $66 | 3.4% | |
| D0230 - intraoral - periapical each additional radiographic image | Diagnostic | 102 | 99 | $3,234 | $3,079 | $32 | $31 | 0.5% | |
| D1110 - prophylaxis - adult | Preventive | 240 | 227 | $28,397 | $26,110 | $118 | $115 | 4.6% | |
| D0220 - intraoral - periapical first radiographic image | Diagnostic | 121 | 113 | $4,581 | $4,212 | $38 | $37 | 0.7% | |
| D0274 - bitewings - four radiographic images | Diagnostic | 129 | 126 | $10,643 | $10,153 | $83 | $81 | 1.8% | |
| D1206 - topical application of fluoride varnish | Preventive | 104 | 85 | $4,916 | $4,113 | $47 | $48 | 0.7% | |
| D1120 - prophylaxis - child | Preventive | 102 | 100 | $8,910 | $8,602 | $87 | $86 | 1.5% | |
| D8670 - periodic orthodontic treatment visit | Orthodontics | 87 | 71 | $14,229 | $6,032 | $164 | $85 | 1.1% | |
| D2150 - amalgam - two surfaces, primary or permanent | Restorative | 38 | 38 | $10,890 | $7,923 | $287 | $209 | 1.4% | |
| D0150 - comprehensive oral evaluation - new or established patient | Diagnostic | 44 | 43 | $5,172 | $4,941 | $118 | $115 | 0.9% | |
| Remaining Procedure Codes | 727 | 522 | $226,020 | $92,899 | $311 | $178 | 16.2% | ||
| Sub Total | 1,995 | 1,717 | $337,249 | $187,521 | $169 | $109 | 32.8% | ||
| Total | 9,041 | 7,587 | $1,353,535 | $572,393 | $150 | $75 | 100.0% |
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Sheet6
Group ID: 1019974
| Group Effective Date: 1/1/2016 | |
| Distribution of Accessing Member by Cost Range |
Group Renewal Month Day: 01/01
Group Policy Number: 0906435
| CITY OF BURLESON | |
| Business Category: PPO |
Service Date Range: 12/1/2023 to 11/30/2025
Product ID: *
| Cost Range | Individual | Cumulative | ||
| Count | Percent | Count | Percent | |
| A: $0-$200 | 82 | 12.69% | 82 | 12.69% |
| B: $201-$400 | 116 | 17.96% | 198 | 30.65% |
| C: $401-$600 | 120 | 18.58% | 318 | 49.23% |
| D: $601-$800 | 95 | 14.71% | 413 | 63.93% |
| E: $801-$1000 | 41 | 6.35% | 454 | 70.28% |
| F: $1001-$1500 | 92 | 14.24% | 546 | 84.52% |
| G: $1501-$2000 | 42 | 6.50% | 588 | 91.02% |
| H: $2001-$2500 | 29 | 4.49% | 617 | 95.51% |
| I: >= $2501 | 29 | 4.49% | 646 | 100.00% |
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