16-J-3 - Delta Dental - Provider Utilization Report.xlsx

This is a Provider Utilization Report submitted by Delta Dental for the Saint Louis Public Schools (SLPS) District, documenting dental plan experience for the period January 1, 2025, through December 31, 2025. The report details claims data for a network of 1,000 dental providers across PPO, Premier, and Non-Par (out-of-network) categories. The SLPS District seeks to contract with firms to provide comprehensive benefit plans for active and retired employees, including medical and prescription drug coverage, employee assistance plans, wellness programs, dental plans, vision plans, basic life and accidental death and dismemberment insurance, voluntary life insurance, long-term disability, and short-term disability. The dental component, managed through Delta Dental, maintains a broad provider network with significant participation across the Saint Louis metropolitan area and surrounding regions in Missouri and Illinois.

The utilization report indicates strong network engagement with 13,844 total claims processed during the reporting period, generating $1,156,866 in paid claims. The PPO network represents the largest segment with 690 providers (69.00% of network), 11,127 services (80.37%), and $973,087 in paid claims (84.11%). The Premier network comprises 230 providers (23.00%), 2,301 services (16.62%), and $162,854 in paid claims (14.08%), while the Non-Par category includes 80 providers (8.00%), 416 services (3.00%), and $20,925 in paid claims (1.81%). Provider specialties encompass general dentistry, orthodontics, pediatric dentistry, oral surgery, periodontics, endodontics, and prosthodontics, with individual providers demonstrating varying utilization levels ranging from minimal single-claim activity to high-volume practitioners processing hundreds of claims. The report serves as a baseline for evaluating network performance and provider compensation under the current benefit arrangement.