Attachment_G-Updated_Experience_Report.xlsx

XLSX spreadsheet 91 KB Posted Aug 3, 2015

Attached to: Group Dental Plan State and local contract opportunity
Solicitation number: 048-PLA-0515
Issued by: Polk County, Florida

About this file

Written by GovTribe AI · Jan 8, 2026

This is a Delta Dental Risk Standard Report Package for The School Board of Polk County, Florida (Group Number 15247), documenting dental insurance experience data covering the 24-month period from April 1, 2013 through March 31, 2015. The report provides comprehensive financial and utilization analysis across multiple divisions within the school board's dental plan, which covered an average of approximately 9,057 to 9,108 primary enrollees during the reporting periods.

The financial data reveals that during the April 2013 to March 2014 period, total premium revenue was $4,470,173 with incurred claims of $3,822,216 (85.5% of premium), while the subsequent April 2014 to March 2015 period generated $4,660,690 in premiums with incurred claims of $3,647,533 (78.3% of premium), indicating improved plan performance. Network utilization shows Delta Dental PPO represented the largest component at approximately 56% of approved amounts, followed by non-contracted providers at 31% and Delta Dental Premier at 13%. Cost analysis for the 2014-2015 period indicates total submitted charges of $9,488,287, with provider discounts of $2,145,311 (22.6%), plan payments of $3,518,656 (37.1%), and patient liability of $3,108,580 (32.8%). Distribution of services by approved amount shows major restorative services (crowns, implants, prosthodontics) representing the largest expense category at 38-39% of costs, followed by basic restorative services at 34% and diagnostic/preventive services at 27%. The plan covered enrollment across multiple tiers including individual enrollees, enrollee plus spouse, and family plans, with relatively stable enrollment trends throughout the 24-month period.

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Other files for this state and local contract opportunity

Other files attached to Group Dental Plan, newest first.
File	Type	Posted
048-PLA-0515_Renewal_for_2021_and_2022.pdf	PDF	Jun 11, 2020
RFP_048-PLA-0515_Board_Approval_Renewal_2019-2020.pdf	PDF	Aug 1, 2018
048-PLA-0515_Renewal_RFP-Group_Dental_Plan_2018-2020_.pdf	PDF	Jul 19, 2018
Attachment_B-Top_Dentist_List.xlsx	XLSX spreadsheet	Aug 3, 2015
Attachment_D-Certificate_of_Coverage.pdf	PDF	Aug 3, 2015
NRBA_048-PLA-0515.pdf	PDF	Aug 3, 2015
Attachment_A-RFP_Proposal_Worksheet_REVISED.docx	DOCX document	Aug 3, 2015
Attachment_A-_RFP_Proposal_Worksheet.docx	DOCX document	Aug 3, 2015
Attachment_B-Top_Dentist_List_REVISED.xlsx	XLSX spreadsheet	Aug 3, 2015
Attachment_E-Census.xlsx	XLSX spreadsheet	Aug 3, 2015
Attachment_F-Dental_Claims_Experience_.zip	ZIP file	Aug 3, 2015
048-PLA-0515_RFP-Group_Dental_Plan_.pdf	PDF	Aug 3, 2015
Addendum_01.pdf	PDF	Aug 3, 2015
Attachment_C-_Top_Dental_Procedures.xlsx	XLSX spreadsheet	Aug 3, 2015
Addendum_02.pdf	PDF	Aug 3, 2015
Award_048-PLA-0515.pdf	PDF	Aug 3, 2015

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DELTA DENTAL RISK STANDARD REPORT PACKAGE

THE SCHOOL BOARD OF POLK CO

Group Number: 15247

04/08/2015

TOC

TABLE OF CONTENTS

THE SCHOOL BOARD OF POLK CO

Group Number: 15247

Tab Report Title

1	FINANCIAL EXPERIENCE REPORT
2	MONTHLY FINANCIAL EXPERIENCE
3	MONTHLY PRIMARY ENROLLEES BY TIER
4	MONTHLY FINANCIAL EXPERIENCE BY DIVISION
5	NETWORK UTILIZATION REPORT BY APPROVED AMOUNT (Excluding Orthodontics)
6	DISTRIBUTION OF SERVICES BY APPROVED AMOUNT (Excluding Orthodontics)
7	DISTRIBUTION OF SERVICES BY APPROVED NUMBER OF PROCEDURES
	(Excluding Orthodontics)
8	DISTRIBUTION OF SERVICES BY APPROVED AMOUNT AND NUMBER OF PROCEDURES
	BY NETWORK (Excluding Orthodontics)
9	COST SAVINGS REPORT (Excluding Orthodontics)

DELTA DENTAL INSURANCE COMPANY
FINANCIAL EXPERIENCE REPORT
THE SCHOOL BOARD OF POLK CO
Group Number: 15247
Paid Period: April 1, 2013 - March 31, 2015 and
Incurred Period: April 1, 2013 - March 31, 2014
		SUMMARY OF EXPERIENCE (Risk*)
Primary Enrollee Months**		108,688
Average Primary Enrollees		9,057
Premium		$4,470,173	100.0%
	Administration Charge	$771,319	17.3%
	Incurred Claims	$3,822,216	85.5%
Total Plan Costs		$4,593,535	102.8%

Paid Period: April 1, 2014 - March 31, 2015 and
Incurred Period: April 1, 2014 - March 31, 2015
		SUMMARY OF EXPERIENCE (Risk*)
Primary Enrollee Months**		109,293
Average Primary Enrollees		9,108
Premium		$4,660,690	100.0%
	Administration Charge	$540,408	11.6%
	Incurred Claims***	$3,647,533	78.3%
Total Plan Costs		$4,187,941	89.9%

* Risk = Non Retention, Guaranteed Administration or Retention.

** Primary Enrollee Months = Total monthly primary enrollees during paid period.

*** Includes estimate for incurred but unreported (IBUR).

	DELTA DENTAL INSURANCE COMPANY
	MONTHLY FINANCIAL EXPERIENCE
	THE SCHOOL BOARD OF POLK CO
	Group Number: 15247
	Paid and Incurred Period: April 1, 2013 - March 31, 2015
	Date	Primary
Enrollees	Premium	Administration
Charge	Incurred Claims*
	Apr-13	9,117	$368,225	$71,833	$305,323
	May-13	9,120	$371,753	$72,522	$266,784
	Jun-13	9,130	$371,167	$72,407	$350,254
	Jul-13	9,146	$369,392	$72,061	$444,954
	Aug-13	9,142	$370,335	$72,245	$339,868
	Sep-13	8,808	$359,254	$70,084	$207,034
	Oct-13	8,791	$359,049	$70,044	$270,072
	Nov-13	8,924	$363,089	$70,831	$265,196
	Dec-13	8,947	$363,752	$70,961	$305,471
	Jan-14	9,207	$414,373	$50,755	$378,660
	Feb-14	9,187	$414,011	$50,813	$337,519
	Mar-14	9,169	$345,774	$26,763	$351,081
	Apr-14	9,154	$391,496	$42,907	$292,554
	May-14	9,138	$393,218	$43,096	$243,791
	Jun-14	9,127	$389,476	$42,685	$342,656
	Jul-14	9,122	$386,591	$42,369	$410,558
	Aug-14	9,117	$391,016	$42,854	$300,524
	Sep-14	8,773	$377,383	$41,360	$237,015
	Oct-14	8,758	$372,722	$40,849	$231,510
	Nov-14	9,056	$382,013	$41,867	$256,644
	Dec-14	9,110	$383,335	$42,012	$300,107
	Jan-15	9,335	$399,629	$53,685	$372,332
	Feb-15	9,321	$401,060	$53,921	$324,860
	Mar-15	9,282	$392,750	$52,802	$334,980
	Total	217,981	$9,130,862	$1,311,728	$7,469,749
	Note: The number of primary enrollees may change to include retroactive additions and/or deletions in eligibility.
	* Includes estimate for incurred but unreported (IBUR).

	DELTA DENTAL INSURANCE COMPANY
	MONTHLY PRIMARY ENROLLEES BY TIER
	THE SCHOOL BOARD OF POLK CO
	Group Number: 15247
	April 1, 2013 - March 31, 2015
	Date	Enrollee Only	Enrollee +
Spouse	Enrollee +
1 Child	Enrollee +
Children	Family	Total
	Apr-13	5,449	1,357	635	670	1,006	9,117
	May-13	5,445	1,356	635	671	1,013	9,120
	Jun-13	5,455	1,352	637	672	1,014	9,130
	Jul-13	5,465	1,355	633	674	1,019	9,146
	Aug-13	5,457	1,356	637	675	1,017	9,142
	Sep-13	5,232	1,324	618	652	982	8,808
	Oct-13	5,220	1,320	618	656	977	8,791
	Nov-13	5,328	1,324	632	659	981	8,924
	Dec-13	5,343	1,332	630	659	983	8,947
	Jan-14	5,446	1,364	670	703	1,024	9,207
	Feb-14	5,428	1,363	673	703	1,020	9,187
	Mar-14	5,411	1,363	677	705	1,013	9,169
	Apr-14	5,390	1,364	676	711	1,013	9,154
	May-14	5,386	1,359	678	708	1,007	9,138
	Jun-14	5,382	1,353	678	706	1,008	9,127
	Jul-14	5,372	1,351	682	707	1,010	9,122
	Aug-14	5,365	1,351	683	708	1,010	9,117
	Sep-14	5,149	1,320	652	680	972	8,773
	Oct-14	5,140	1,316	653	680	969	8,758
	Nov-14	5,333	1,339	683	710	991	9,056
	Dec-14	5,373	1,347	685	708	997	9,110
	Jan-15	5,513	1,361	718	729	1,014	9,335
	Feb-15	5,501	1,365	718	726	1,011	9,321
	Mar-15	5,471	1,363	715	725	1,008	9,282
	Total	129,054	32,355	15,916	16,597	24,059	217,981
	Note: The number of primary enrollees may change to include retroactive additions and/or deletions in eligibility.

	DELTA DENTAL INSURANCE COMPANY
	MONTHLY FINANCIAL EXPERIENCE BY DIVISION
	THE SCHOOL BOARD OF POLK CO
	Group Number: 15247
	Paid and Incurred Period: April 1, 2013 - March 31, 2015
	Group-
Division	Date	Premium	Administration
Charge	Incurred Claims*	Enrollee Only	Enrollee +
Spouse	Enrollee +
1 Child	Enrollee +
Children	Family	Total
	15247-00001	Apr-13	$29,100	$5,671	$17,961	1,049	139	124	89	159	1,560
	15247-00001	May-13	$29,611	$5,771	$18,988	1,040	140	124	90	162	1,556
	15247-00001	Jun-13	$29,092	$5,670	$24,688	1,039	141	125	89	162	1,556
	15247-00001	Jul-13	$29,305	$5,711	$27,646	1,036	144	124	90	162	1,556
	15247-00001	Aug-13	$29,191	$5,689	$21,189	1,032	144	125	90	160	1,551
	15247-00001	Sep-13	$27,416	$5,343	$11,743	960	136	117	86	150	1,449
	15247-00001	Oct-13	$27,229	$5,307	$14,474	957	133	117	86	150	1,443
	15247-00001	Nov-13	$27,910	$5,439	$16,137	984	135	124	85	154	1,482
	15247-00001	Dec-13	$27,880	$5,433	$14,779	987	134	122	85	153	1,481
	15247-00001	Jan-14	$27,143	$3,647	$15,374	974	128	123	75	147	1,447
	15247-00001	Feb-14	$29,911	$4,020	$13,873	970	128	125	73	144	1,440
	15247-00001	Mar-14	$20,890	$695	$20,402	967	129	123	73	145	1,437
	15247-00001	Apr-14	$26,796	$2,937	$15,399	961	129	122	73	145	1,430
	15247-00001	May-14	$26,547	$2,910	$12,536	959	128	121	72	143	1,423
	15247-00001	Jun-14	$26,548	$2,910	$22,627	964	125	122	71	144	1,426
	15247-00001	Jul-14	$26,616	$2,917	$27,615	965	126	123	71	144	1,429
	15247-00001	Aug-14	$26,616	$2,917	$16,996	966	126	124	71	145	1,432
	15247-00001	Sep-14	$25,366	$2,780	$15,057	918	114	119	68	139	1,358
	15247-00001	Oct-14	$25,963	$2,846	$13,125	917	113	120	67	139	1,356
	15247-00001	Nov-14	$25,646	$2,811	$19,750	962	121	131	70	146	1,430
	15247-00001	Dec-14	$27,021	$2,962	$15,383	980	121	130	70	148	1,449
	15247-00001	Jan-15	$26,930	$3,614	$17,287	991	112	134	61	144	1,442
	15247-00001	Feb-15	$26,850	$3,609	$15,564	985	112	135	61	143	1,436
	15247-00001	Mar-15	$26,094	$3,507	$18,917	975	111	134	61	143	1,424
	15247-00002	Apr-13	$139,614	$27,232	$94,805	1,966	405	335	408	518	3,632
	15247-00002	May-13	$138,004	$26,918	$79,309	1,972	405	335	407	521	3,640
	15247-00002	Jun-13	$139,869	$27,281	$124,769	1,979	402	336	407	522	3,646
	15247-00002	Jul-13	$140,966	$27,495	$178,063	1,985	404	335	407	526	3,657
	15247-00002	Aug-13	$139,006	$27,113	$113,160	1,984	402	336	409	526	3,657
	15247-00002	Sep-13	$133,913	$26,120	$66,008	1,872	382	328	397	510	3,489
	15247-00002	Oct-13	$133,134	$25,968	$77,638	1,869	379	328	400	509	3,485
	15247-00002	Nov-13	$136,261	$26,578	$87,612	1,925	379	336	403	509	3,552
	15247-00002	Dec-13	$137,049	$26,731	$88,708	1,934	386	339	404	512	3,575
	15247-00002	Jan-14	$169,946	$22,823	$141,109	2,128	430	379	471	570	3,978
	15247-00002	Feb-14	$169,801	$22,821	$127,349	2,122	426	380	474	571	3,973
	15247-00002	Mar-14	$115,612	$4,136	$126,275	2,118	424	386	473	567	3,968
	15247-00002	Apr-14	$153,420	$16,809	$114,161	2,113	423	387	476	571	3,970
	15247-00002	May-14	$153,592	$16,827	$100,515	2,113	420	390	474	571	3,968
	15247-00002	Jun-14	$153,079	$16,771	$139,333	2,109	420	388	473	572	3,962
	15247-00002	Jul-14	$153,218	$16,786	$188,017	2,104	417	389	474	575	3,959
	15247-00002	Aug-14	$152,841	$16,745	$131,031	2,097	417	389	475	576	3,954
	15247-00002	Sep-14	$146,168	$16,014	$91,857	1,965	392	374	460	554	3,745
	15247-00002	Oct-14	$141,985	$15,556	$88,477	1,961	390	376	460	552	3,739
	15247-00002	Nov-14	$158,230	$17,335	$105,639	2,077	402	394	480	563	3,916
	15247-00002	Dec-14	$149,095	$16,335	$114,090	2,094	407	399	480	566	3,946
	15247-00002	Jan-15	$161,402	$21,680	$123,262	2,178	433	424	497	590	4,122
	15247-00002	Feb-15	$160,385	$21,566	$125,091	2,177	428	425	494	590	4,114
	15247-00002	Mar-15	$159,078	$21,390	$133,859	2,164	427	423	493	588	4,095
	15247-00003	Apr-13	$151,096	$29,484	$131,684	1,598	432	166	169	312	2,677
	15247-00003	May-13	$155,996	$30,440	$110,269	1,599	430	166	170	313	2,678
	15247-00003	Jun-13	$153,829	$30,017	$159,365	1,603	429	166	172	313	2,683
	15247-00003	Jul-13	$151,190	$29,502	$189,414	1,607	428	164	173	314	2,686
	15247-00003	Aug-13	$153,569	$29,967	$153,402	1,602	428	166	172	313	2,681
	15247-00003	Sep-13	$147,663	$28,814	$77,331	1,526	406	162	163	302	2,559
	15247-00003	Oct-13	$147,768	$28,834	$115,600	1,514	407	163	164	299	2,547
	15247-00003	Nov-13	$147,016	$28,688	$117,053	1,535	404	163	165	300	2,567
	15247-00003	Dec-13	$147,596	$28,801	$135,701	1,533	405	161	164	300	2,563
	15247-00003	Jan-14	$160,216	$17,541	$155,439	1,454	399	159	153	288	2,453
	15247-00003	Feb-14	$156,143	$17,117	$141,683	1,442	399	159	152	282	2,434
	15247-00003	Mar-14	$157,455	$17,184	$144,350	1,434	393	159	155	278	2,419
	15247-00003	Apr-14	$154,880	$16,979	$97,953	1,427	393	158	158	275	2,411
	15247-00003	May-14	$156,043	$17,106	$81,275	1,426	391	158	158	271	2,404
	15247-00003	Jun-14	$153,524	$16,830	$131,768	1,419	388	159	159	270	2,395
	15247-00003	Jul-14	$150,143	$16,459	$143,516	1,414	387	161	159	269	2,390
	15247-00003	Aug-14	$154,745	$16,964	$103,533	1,415	383	160	158	268	2,384
	15247-00003	Sep-14	$146,375	$16,046	$80,812	1,320	365	149	150	256	2,240
	15247-00003	Oct-14	$145,533	$15,954	$84,829	1,315	363	147	151	255	2,231
	15247-00003	Nov-14	$138,995	$15,237	$89,717	1,344	366	148	157	258	2,273
	15247-00003	Dec-14	$147,509	$16,170	$123,011	1,351	366	146	154	258	2,275
	15247-00003	Jan-15	$152,271	$20,455	$144,624	1,393	359	151	168	255	2,326
	15247-00003	Feb-15	$151,115	$20,316	$105,562	1,386	357	149	169	253	2,314
	15247-00003	Mar-15	$146,342	$19,674	$115,010	1,377	357	149	169	251	2,303
	15247-08001	Apr-13	$1,992	$388	$1,170	100	25	0	0	2	127
	15247-08001	May-13	$1,954	$381	$2,271	100	25	0	0	2	127
	15247-08001	Jun-13	$1,917	$373	$3,144	97	25	0	0	2	124
	15247-08001	Jul-13	$1,051	$205	$1,597	97	25	0	0	2	124
	15247-08001	Aug-13	$1,879	$366	$1,113	97	25	0	0	2	124
	15247-08001	Sep-13	$1,991	$388	$1,890	98	29	0	0	2	129
	15247-08001	Oct-13	$2,016	$393	$2,289	99	29	0	0	2	130
	15247-08001	Nov-13	$2,016	$393	$1,835	99	29	0	0	2	130
	15247-08001	Dec-13	$2,066	$403	$2,848	101	30	0	0	2	133
	15247-08001	Jan-14	$2,172	$295	$2,823	99	26	0	0	2	127
	15247-08001	Feb-14	$2,222	$299	$2,624	100	26	0	0	3	129
	15247-08001	Mar-14	$1,570	$68	$1,531	100	26	0	0	3	129
	15247-08001	Apr-14	$1,992	$218	$2,613	99	27	0	0	2	128
	15247-08001	May-14	$1,979	$217	$1,223	98	27	0	0	2	127
	15247-08001	Jun-14	$1,967	$216	$2,794	97	27	0	0	2	126
	15247-08001	Jul-14	$1,954	$214	$2,753	96	27	0	0	2	125
	15247-08001	Aug-14	$1,997	$219	$2,608	97	27	1	0	2	127
	15247-08001	Sep-14	$2,135	$234	$2,121	101	30	1	0	2	134
	15247-08001	Oct-14	$2,110	$231	$1,901	101	29	1	0	2	133
	15247-08001	Nov-14	$2,047	$224	$1,392	102	30	1	0	2	135
	15247-08001	Dec-14	$2,116	$232	$1,965	102	30	1	0	2	135
	15247-08001	Jan-15	$2,104	$283	$1,777	99	28	0	0	2	129
	15247-08001	Feb-15	$1,928	$259	$2,632	98	29	0	0	2	129
	15247-08001	Mar-15	$2,054	$276	$2,001	98	29	0	0	2	129
	15247-08002	Apr-13	$12,443	$2,427	$11,900	270	137	8	0	6	421
	15247-08002	May-13	$12,551	$2,448	$13,618	270	138	8	0	6	422
	15247-08002	Jun-13	$12,475	$2,433	$12,933	272	138	8	0	6	424
	15247-08002	Jul-13	$12,646	$2,467	$15,809	275	137	8	0	6	426
	15247-08002	Aug-13	$12,691	$2,475	$9,772	272	139	8	0	7	426
	15247-08002	Sep-13	$13,145	$2,564	$14,344	288	146	8	0	8	450
	15247-08002	Oct-13	$13,555	$2,644	$15,345	291	147	8	0	7	453
	15247-08002	Nov-13	$13,728	$2,678	$9,338	294	150	7	0	7	458
	15247-08002	Dec-13	$13,749	$2,682	$10,615	296	150	6	0	8	460
	15247-08002	Jan-14	$16,476	$2,222	$17,368	319	163	6	0	7	495
	15247-08002	Feb-14	$16,680	$2,242	$16,111	322	164	6	0	8	500
	15247-08002	Mar-14	$11,861	$479	$14,554	322	167	6	0	8	503
	15247-08002	Apr-14	$15,175	$1,663	$18,795	321	167	6	0	8	502
	15247-08002	May-14	$15,261	$1,673	$18,568	323	169	6	0	8	506
	15247-08002	Jun-14	$15,218	$1,668	$15,029	323	169	6	0	8	506
	15247-08002	Jul-14	$15,240	$1,670	$14,409	323	169	6	0	8	506
	15247-08002	Aug-14	$15,358	$1,683	$17,354	322	171	6	0	8	507
	15247-08002	Sep-14	$16,730	$1,834	$13,025	346	188	6	0	10	550
	15247-08002	Oct-14	$16,838	$1,846	$14,099	345	191	6	0	10	552
	15247-08002	Nov-14	$16,795	$1,841	$12,282	346	190	6	0	11	553
	15247-08002	Dec-14	$16,880	$1,850	$13,294	344	192	6	1	12	555
	15247-08002	Jan-15	$16,544	$2,229	$19,970	351	197	6	1	10	565
	15247-08002	Feb-15	$18,106	$2,434	$21,745	353	204	6	1	10	574
	15247-08002	Mar-15	$17,714	$2,381	$19,445	356	203	6	1	11	577
	15247-08003	Apr-13	$33,201	$6,479	$46,289	443	217	1	2	8	671
	15247-08003	May-13	$32,911	$6,423	$41,827	441	216	1	2	8	668
	15247-08003	Jun-13	$32,825	$6,406	$25,027	443	215	1	2	8	669
	15247-08003	Jul-13	$32,944	$6,429	$32,328	443	215	1	2	8	669
	15247-08003	Aug-13	$33,093	$6,458	$40,437	446	216	1	2	8	673
	15247-08003	Sep-13	$34,543	$6,741	$34,489	463	223	2	3	9	700
	15247-08003	Oct-13	$34,551	$6,743	$43,392	463	223	1	3	9	699
	15247-08003	Nov-13	$34,688	$6,770	$32,939	464	225	1	3	9	702
	15247-08003	Dec-13	$34,647	$6,762	$51,987	468	225	1	3	8	705
	15247-08003	Jan-14	$37,729	$4,140	$45,061	450	216	2	2	9	679
	15247-08003	Feb-14	$38,381	$4,208	$35,721	449	218	2	2	11	682
	15247-08003	Mar-14	$38,386	$4,202	$39,873	448	221	2	2	11	684
	15247-08003	Apr-14	$38,549	$4,226	$42,222	449	222	2	2	11	686
	15247-08003	May-14	$38,425	$4,213	$29,136	448	222	2	2	11	685
	15247-08003	Jun-14	$38,303	$4,199	$30,980	451	222	2	2	11	688
	15247-08003	Jul-14	$38,425	$4,213	$32,894	451	223	2	2	11	689
	15247-08003	Aug-14	$38,626	$4,235	$28,824	451	225	2	2	11	691
	15247-08003	Sep-14	$39,872	$4,371	$33,966	477	228	2	1	10	718
	15247-08003	Oct-14	$39,875	$4,372	$26,616	478	228	2	1	10	719
	15247-08003	Nov-14	$38,848	$4,259	$27,470	480	229	2	1	10	722
	15247-08003	Dec-14	$39,778	$4,361	$29,808	480	230	2	1	10	723
	15247-08003	Jan-15	$39,277	$5,279	$64,526	481	231	2	1	11	726
	15247-08003	Feb-15	$41,601	$5,592	$53,165	484	235	2	1	11	733
	15247-08003	Mar-15	$40,538	$5,449	$44,900	484	236	2	1	11	734
	15247-09001	Apr-13	-$30	-$6	$460	5	1	0	0	0	6
	15247-09001	May-13	-$98	-$19	$0	3	1	0	0	0	4
	15247-09001	Jun-13	$63	$12	$0	2	1	0	0	0	3
	15247-09001	Jul-13	$175	$34	$0	2	1	0	0	0	3
	15247-09001	Aug-13	$86	$17	$0	3	1	0	0	0	4
	15247-09001	Sep-13	$55	$11	$0	4	1	0	0	0	5
	15247-09001	Oct-13	$75	$15	$0	4	1	0	0	0	5
	15247-09001	Nov-13	$0	$0	$0	4	1	0	0	0	5
	15247-09001	Dec-13	$175	$34	$0	2	0	0	0	0	2
	15247-09001	Jan-14	$22	$7	$0	2	0	0	0	0	2
	15247-09001	Feb-14	$42	$6	$0	2	0	0	0	0	2
	15247-09001	Mar-14	$0	$0	$0	2	0	0	0	0	2
	15247-09001	Apr-14	$13	$1	$0	2	0	0	0	0	2
	15247-09001	May-14	$13	$1	$0	2	0	0	0	0	2
	15247-09001	Jun-14	$13	$1	$0	2	0	0	0	0	2
	15247-09001	Jul-14	$13	$1	$0	2	0	0	0	0	2
	15247-09001	Aug-14	$13	$1	$0	2	0	0	1	0	3
	15247-09001	Sep-14	$43	$5	$0	3	0	0	0	0	3
	15247-09001	Oct-14	$38	$4	$0	3	0	0	0	0	3
	15247-09001	Nov-14	$25	$3	$0	3	0	0	0	0	3
	15247-09001	Dec-14	$25	$3	$0	3	0	0	0	0	3
	15247-09001	Jan-15	$25	$3	$0	3	0	0	0	1	4
	15247-09001	Feb-15	$25	$3	$0	2	0	0	0	1	3
	15247-09001	Mar-15	$25	$3	$0	2	0	0	0	1	3
	15247-09002	Apr-13	$650	$127	$1,055	11	0	1	1	1	14
	15247-09002	May-13	$450	$88	$462	12	0	1	1	1	15
	15247-09002	Jun-13	$422	$82	$330	12	0	1	1	1	15
	15247-09002	Jul-13	$734	$143	$51	12	0	1	1	1	15
	15247-09002	Aug-13	$460	$90	$229	13	0	1	1	1	16
	15247-09002	Sep-13	$222	$43	$344	13	0	1	1	1	16
	15247-09002	Oct-13	$266	$52	$367	13	0	1	1	1	16
	15247-09002	Nov-13	$578	$113	$0	13	0	1	1	0	15
	15247-09002	Dec-13	$379	$74	$90	11	1	1	1	0	14
	15247-09002	Jan-14	$236	$23	$1,195	11	1	1	1	0	14
	15247-09002	Feb-14	$386	$52	$158	11	1	1	1	0	14
	15247-09002	Mar-14	$0	$0	$300	10	2	1	1	0	14
	15247-09002	Apr-14	$178	$19	$81	9	2	1	1	0	13
	15247-09002	May-14	$347	$38	$430	9	1	1	1	0	12
	15247-09002	Jun-14	$455	$50	$0	9	1	1	0	0	11
	15247-09002	Jul-14	$304	$33	$0	9	1	1	0	0	11
	15247-09002	Aug-14	$183	$20	$0	9	1	1	0	0	11
	15247-09002	Sep-14	$292	$32	$50	10	2	1	0	0	13
	15247-09002	Oct-14	$379	$42	$151	10	2	1	0	0	13
	15247-09002	Nov-14	$401	$44	$115	10	1	1	1	0	13
	15247-09002	Dec-14	$271	$30	$448	10	1	1	1	0	13
	15247-09002	Jan-15	$478	$62	$10	10	1	1	1	0	13
	15247-09002	Feb-15	$369	$50	$10	10	0	1	0	0	11
	15247-09002	Mar-15	$347	$47	$177	9	0	1	0	0	10
	15247-09003	Apr-13	$160	$31	$0	7	1	0	1	0	9
	15247-09003	May-13	$373	$73	$40	8	1	0	1	0	10
	15247-09003	Jun-13	$676	$132	$0	8	1	0	1	0	10
	15247-09003	Jul-13	$381	$74	$46	8	1	0	1	0	10
	15247-09003	Aug-13	$361	$70	$567	8	1	0	1	0	10
	15247-09003	Sep-13	$307	$60	$885	8	1	0	2	0	11
	15247-09003	Oct-13	$455	$89	$966	10	1	0	2	0	13
	15247-09003	Nov-13	$891	$174	$282	10	1	0	2	0	13
	15247-09003	Dec-13	$211	$41	$743	11	1	0	2	0	14
	15247-09003	Jan-14	$434	$58	$290	9	1	0	1	1	12
	15247-09003	Feb-14	$445	$49	$0	10	1	0	1	1	13
	15247-09003	Mar-14	$0	$0	$3,797	10	1	0	1	1	13
	15247-09003	Apr-14	$494	$54	$1,330	9	1	0	1	1	12
	15247-09003	May-14	$1,011	$111	$109	8	1	0	1	1	11
	15247-09003	Jun-14	$370	$41	$125	8	1	0	1	1	11
	15247-09003	Jul-14	$679	$74	$1,354	8	1	0	1	1	11
	15247-09003	Aug-14	$638	$70	$178	6	1	0	1	0	8
	15247-09003	Sep-14	$401	$44	$127	9	1	0	1	1	12
	15247-09003	Oct-14	$2	$0	$2,313	10	0	0	1	1	12
	15247-09003	Nov-14	$1,026	$112	$280	9	0	0	1	1	11
	15247-09003	Dec-14	$640	$70	$2,108	9	0	0	1	1	11
	15247-09003	Jan-15	$599	$81	$876	7	0	0	0	1	8
	15247-09003	Feb-15	$682	$92	$1,092	6	0	0	0	1	7
	15247-09003	Mar-15	$558	$75	$670	6	0	0	0	1	7
	Total		$9,130,862	$1,311,728	$7,469,749	129,054	32,355	15,916	16,597	24,059	217,981
	Note: The number of primary enrollees may change to include retroactive additions and/or deletions in eligibility.
	* Includes estimate for incurred but unreported (IBUR).

DELTA DENTAL INSURANCE COMPANY

NETWORK UTILIZATION REPORT BY APPROVED AMOUNT (Excluding Orthodontics)

THE SCHOOL BOARD OF POLK CO

Group Number: 15247

Paid Period: April 1, 2013 - March 31, 2014
	Approved Amount	PEPM		Benchmark	Number of Procedures		Benchmark
Delta Dental PPO	$3,998,975	$36.79	56.7%	51.0%	43,266	66.2%	57.2%
Delta Dental Premier	$933,248	$8.59	13.2%	29.4%	8,203	12.6%	28.7%
Non-Contracted	$2,122,140	$19.53	30.1%	19.6%	13,892	21.3%	14.2%
Total	$7,054,363	$64.90	100.0%	100.0%	65,361	100.0%	100.0%

Paid Period: April 1, 2014 - March 31, 2015
	Approved Amount	PEPM		Benchmark	Number of Procedures		Benchmark
Delta Dental PPO	$4,008,614	$36.68	56.4%	51.7%	46,159	67.9%	58.3%
Delta Dental Premier	$915,441	$8.38	12.9%	29.0%	7,942	11.7%	27.9%
Non-Contracted	$2,180,694	$19.95	30.7%	19.4%	13,847	20.4%	13.7%
Total	$7,104,749	$65.01	100.0%	100.0%	67,948	100.0%	100.0%

Note: Benchmark based on statewide averages. Results may vary due to benefit design, industry, age and area location.

DELTA DENTAL INSURANCE COMPANY
DISTRIBUTION OF SERVICES BY APPROVED AMOUNT (Excluding Orthodontics)
THE SCHOOL BOARD OF POLK CO
Group Number: 15247
Paid Period: April 1, 2013 - March 31, 2014 compared to April 1, 2014 - March 31, 2015
Service Type	Procedure Codes	4/1/2013 - 3/31/2014	PEPM		4/1/2014 - 3/31/2015	PEPM		Benchmark
D&P	Diagnostic (D0100 - D0999)	$997,547	$9.18	14.1%	$1,039,167	$9.51	14.6%	17.5%
	Preventive (D1000 - D1999)	$885,808	$8.15	12.6%	$909,540	$8.32	12.8%	14.4%
	Subtotal	$1,883,355	$17.33	26.7%	$1,948,707	$17.83	27.4%	31.9%

Basic	Restorative (D2000 - D2499)	$771,940	$7.10	10.9%	$774,720	$7.09	10.9%	14.1%
	Endodontics (D3000 - D3999)	$499,138	$4.59	7.1%	$511,638	$4.68	7.2%	6.4%
	Periodontics (D4000 - D4999)	$448,172	$4.12	6.4%	$462,168	$4.23	6.5%	6.6%
	Oral Surgery (D7000 - D7999)	$516,436	$4.75	7.3%	$502,597	$4.60	7.1%	7.4%
	Miscellaneous (D9000 - D9999)*	$161,982	$1.49	2.3%	$183,329	$1.68	2.6%	3.1%
	Subtotal	$2,397,669	$22.06	34.0%	$2,434,453	$22.27	34.3%	37.6%

Major	Crowns & Inlays/Onlays (D2500 - D2999)	$1,713,524	$15.77	24.3%	$1,667,338	$15.26	23.5%	19.5%
	Removable Prosthodontics (D5000 - D5999)	$245,423	$2.26	3.5%	$190,047	$1.74	2.7%	2.3%
	Implant Services (D6000 - D6199)	$419,831	$3.86	6.0%	$445,290	$4.07	6.3%	4.7%
	Fixed Prosthodontics (D6200 - D6999)	$394,561	$3.63	5.6%	$418,915	$3.83	5.9%	4.0%
	Subtotal	$2,773,339	$25.52	39.3%	$2,721,590	$24.90	38.3%	30.5%
	Total	$7,054,363	$64.90	100.0%	$7,104,749	$65.01	100.0%	100.0%
Note: Benchmark based on book of business averages. Results may vary due to benefit design, industry, age and area location.
* Includes Anesthesia, Drugs and Adjunctive General Services

Chart Data	Prior	Current	Benchmark
D&P	26.7%	27.4%	31.9%
Basic	34.0%	34.3%	37.6%
Major	39.3%	38.3%	30.5%

Prior D & P Basic Major 0.26697733057822137 0.3398845031647571 0.39313816625702158 Current D & P Basic Major 0.27428228514298336 0.34265147705482707 0.38306623780218946 Benchmark D & P Basic Major 0.31936314561590523 0.37553581139018444 0.30510104299391028

DELTA DENTAL INSURANCE COMPANY

DISTRIBUTION OF SERVICES BY APPROVED NUMBER OF PROCEDURES (Excluding Orthodontics)

THE SCHOOL BOARD OF POLK CO

Group Number: 15247

Paid Period: April 1, 2013 - March 31, 2014 compared to April 1, 2014 - March 31, 2015
Service Type	Procedure Codes	4/1/2013 - 3/31/2014		4/1/2014 - 3/31/2015		Benchmark
D&P	Diagnostic (D0100 - D0999)	26,970	41.3%	28,726	42.3%	44.9%
	Preventive (D1000 - D1999)	17,352	26.5%	18,003	26.5%	27.7%
	Subtotal	44,322	67.8%	46,729	68.8%	72.6%

Basic	Restorative (D2000 - D2499)	6,071	9.3%	5,936	8.7%	10.2%
	Endodontics (D3000 - D3999)	916	1.4%	923	1.4%	1.1%
	Periodontics (D4000 - D4999)	4,435	6.8%	4,787	7.0%	4.5%
	Oral Surgery (D7000 - D7999)	2,767	4.2%	2,696	4.0%	3.7%
	Miscellaneous (D9000 - D9999)*	1,743	2.7%	1,928	2.8%	2.6%
	Subtotal	15,932	24.4%	16,270	23.9%	22.2%

Major	Crowns & Inlays/Onlays (D2500 - D2999)	3,671	5.6%	3,567	5.2%	3.8%
	Removable Prosthodontics (D5000 - D5999)	471	0.7%	380	0.6%	0.4%
	Implant Services (D6000 - D6199)	395	0.6%	400	0.6%	0.4%
	Fixed Prosthodontics (D6200 - D6999)	570	0.9%	602	0.9%	0.6%
	Subtotal	5,107	7.8%	4,949	7.3%	5.2%
	Total	65,361	100.0%	67,948	100.0%	100.0%
Note: Benchmark based on book of business averages. Results may vary due to benefit design, industry, age and area location.
*Includes Anesthesia, Drugs and Adjunctive General Services

Chart Data	Prior	Current	Benchmark
D&P	67.8%	68.8%	72.6%
Basic	24.4%	23.9%	22.2%
Major	7.8%	7.3%	5.2%

Prior D & P Basic Major 0.67811080001835955 0.24375392053365155 7.8135279447988856E-2 Current D & P Basic Major 0.68771707776534996 0.23944781303349622 7.2835109201153825E-2 Benchmark D & P Basic Major 0.72587049190308528 0.22185284129407939 5.2276666802835325E-2

DELTA DENTAL INSURANCE COMPANY

DISTRIBUTION OF SERVICES BY APPROVED AMOUNT AND NUMBER OF PROCEDURES BY NETWORK (Excluding Orthodontics)

THE SCHOOL BOARD OF POLK CO

Group Number: 15247

Paid Period: April 1, 2013 - March 31, 2014 compared to April 1, 2014 - March 31, 2015
		Delta Dental PPO		Delta Dental PPO		Delta Dental Premier		Delta Dental Premier		Non-Contracted		Non-Contracted		Total	Total
Type of Service	Approved Amount Procedure Codes	4/1/2013 - 3/31/2014		4/1/2014 - 3/31/2015		4/1/2013 - 3/31/2014		4/1/2014 - 3/31/2015		4/1/2013 - 3/31/2014		4/1/2014 - 3/31/2015		4/1/2013 - 3/31/2014	4/1/2014 - 3/31/2015
D&P	Diagnostic (D0100 - D0999)	$559,409	14.0%	$591,255	14.7%	$145,879	15.6%	$140,917	15.4%	$292,259	13.8%	$306,994	14.1%	$997,547	$1,039,167
	Preventive (D1000 - D1999)	$461,006	11.5%	$491,886	12.3%	$137,902	14.8%	$138,445	15.1%	$286,900	13.5%	$279,209	12.8%	$885,808	$909,540
	Subtotal	$1,020,415	25.5%	$1,083,142	27.0%	$283,781	30.4%	$279,362	30.5%	$579,160	27.3%	$586,203	26.9%	$1,883,355	$1,948,707

Basic	Restorative (D2000 - D2499)	$400,011	10.0%	$390,808	9.7%	$133,148	14.3%	$125,847	13.7%	$238,781	11.3%	$258,065	11.8%	$771,940	$774,720
	Endodontics (D3000 - D3999)	$412,195	10.3%	$403,672	10.1%	$37,460	4.0%	$46,704	5.1%	$49,483	2.3%	$61,262	2.8%	$499,138	$511,638
	Periodontics (D4000 - D4999)	$279,380	7.0%	$276,307	6.9%	$31,800	3.4%	$36,308	4.0%	$136,992	6.5%	$149,553	6.9%	$448,172	$462,168
	Oral Surgery (D7000 - D7999)	$333,707	8.3%	$346,477	8.6%	$38,286	4.1%	$31,380	3.4%	$144,444	6.8%	$124,740	5.7%	$516,436	$502,597
	Miscellaneous (D9000 - D9999)*	$114,249	2.9%	$136,363	3.4%	$7,829	0.8%	$5,524	0.6%	$39,904	1.9%	$41,443	1.9%	$161,982	$183,329
	Subtotal	$1,539,542	38.5%	$1,553,627	38.8%	$248,523	26.6%	$245,763	26.8%	$609,603	28.7%	$635,063	29.1%	$2,397,669	$2,434,453

Major	Crowns & Inlays/Onlays (D2500 - D2999)	$896,669	22.4%	$865,906	21.6%	$274,133	29.4%	$255,089	27.9%	$542,722	25.6%	$546,343	25.1%	$1,713,524	$1,667,338
	Removable Prosthodontics (D5000 - D5999)	$118,000	3.0%	$101,905	2.5%	$42,550	4.6%	$28,654	3.1%	$84,873	4.0%	$59,488	2.7%	$245,423	$190,047
	Implant Services (D6000 - D6199)	$196,679	4.9%	$172,870	4.3%	$48,624	5.2%	$44,418	4.9%	$174,528	8.2%	$228,002	10.5%	$419,831	$445,290
	Fixed Prosthodontics (D6200 - D6999)	$227,671	5.7%	$231,164	5.8%	$35,637	3.8%	$62,155	6.8%	$131,253	6.2%	$125,596	5.8%	$394,561	$418,915
	Subtotal	$1,439,019	36.0%	$1,371,845	34.2%	$400,944	43.0%	$390,316	42.6%	$933,377	44.0%	$959,428	44.0%	$2,773,339	$2,721,590
	Total	$3,998,975	100.0%	$4,008,614	100.0%	$933,248	100.0%	$915,441	100.0%	$2,122,140	100.0%	$2,180,694	100.0%	$7,054,363	$7,104,749
	PEPM	$36.79		$36.68		$8.59		$8.38		$19.53		$19.95		$64.90	$65.01

		Delta Dental PPO				Delta Dental Premier				Non-Contracted				Total	Total
Type of Service	Approved Number of Procedures Procedure Codes	4/1/2013 - 3/31/2014		4/1/2014 - 3/31/2015		4/1/2013 - 3/31/2014		4/1/2014 - 3/31/2015		4/1/2013 - 3/31/2014		4/1/2014 - 3/31/2015		4/1/2013 - 3/31/2014	4/1/2014 - 3/31/2015
D&P	Diagnostic (D0100 - D0999)	17,639	40.8%	19,503	42.3%	3,714	45.3%	3,606	45.4%	5,617	40.4%	5,617	40.6%	26,970	28,726
	Preventive (D1000 - D1999)	11,129	25.7%	11,915	25.8%	2,220	27.1%	2,222	28.0%	4,003	28.8%	3,866	27.9%	17,352	18,003
	Subtotal	28,768	66.5%	31,418	68.1%	5,934	72.3%	5,828	73.4%	9,620	69.2%	9,483	68.5%	44,322	46,729

Basic	Restorative (D2000 - D2499)	3,805	8.8%	3,675	8.0%	946	11.5%	889	11.2%	1,320	9.5%	1,372	9.9%	6,071	5,936
	Endodontics (D3000 - D3999)	775	1.8%	715	1.5%	63	0.8%	77	1.0%	78	0.6%	131	0.9%	916	923
	Periodontics (D4000 - D4999)	3,229	7.5%	3,606	7.8%	289	3.5%	257	3.2%	917	6.6%	924	6.7%	4,435	4,787
	Oral Surgery (D7000 - D7999)	1,967	4.5%	1,982	4.3%	249	3.0%	182	2.3%	551	4.0%	532	3.8%	2,767	2,696
	Miscellaneous (D9000 - D9999)*	1,442	3.3%	1,615	3.5%	76	0.9%	66	0.8%	225	1.6%	247	1.8%	1,743	1,928
	Subtotal	11,218	25.9%	11,593	25.1%	1,623	19.8%	1,471	18.5%	3,091	22.3%	3,206	23.2%	15,932	16,270

Major	Crowns & Inlays/Onlays (D2500 - D2999)	2,428	5.6%	2,372	5.1%	469	5.7%	452	5.7%	774	5.6%	743	5.4%	3,671	3,567
	Removable Prosthodontics (D5000 - D5999)	271	0.6%	225	0.5%	79	1.0%	67	0.8%	121	0.9%	88	0.6%	471	380
	Implant Services (D6000 - D6199)	195	0.5%	164	0.4%	56	0.7%	49	0.6%	144	1.0%	187	1.4%	395	400
	Fixed Prosthodontics (D6200 - D6999)	386	0.9%	387	0.8%	42	0.5%	75	0.9%	142	1.0%	140	1.0%	570	602
	Subtotal	3,280	7.6%	3,148	6.8%	646	7.9%	643	8.1%	1,181	8.5%	1,158	8.4%	5,107	4,949
	Total	43,266	100.0%	46,159	100.0%	8,203	100.0%	7,942	100.0%	13,892	100.0%	13,847	100.0%	65,361	67,948

* Includes Anesthesia, Drugs and Adjunctive General Services

[[ Exposure Prior and Current]] ERROR:#REF! ERROR:#REF!

DELTA DENTAL INSURANCE COMPANY

COST SAVINGS REPORT (Excluding Orthodontics)

THE SCHOOL BOARD OF POLK CO

Group Number: 15247

Paid Period: April 1, 2014 - March 31, 2015
		Delta Dental PPO		Delta Dental Premier		Non-Contracted		Total
1)	Total Submitted	$6,133,229	100.0%	$1,083,090	100.0%	$2,271,968	100.0%	$9,488,287	100.0%

2)	Provider Discounts*	$1,990,599	32.5%	$154,712	14.3%	$0	0.0%	$2,145,311	22.6%
	Other Savings**	$432,485	7.1%	$55,090	5.1%	$228,165	10.0%	$715,741	7.5%

Total Savings $2,423,084 39.5% $209,802 19.4% $228,165 10.0% $2,861,051 30.2%

3) Plan Pays $2,197,261 35.8% $457,973 42.3% $863,421 38.0% $3,518,656 37.1%

4) Patient Liability *** $1,512,884 24.7% $415,315 38.3% $1,180,381 52.0% $3,108,580 32.8%

* Provider Discounts includes reduction to fees and non-billable procedures for Delta providers
** Other Savings includes services not payable due to duplicate submissions and missing or invalid information
*** Patient Liability includes non-covered and optional savings, coinsurance, maximums, deductibles and non-contracted provider fees
	Total Submitted	100.0%
	Provider Discounts	22.6%
	Other Savings	7.5%
	Plan Pays	37.1%
	Patient Liability	32.8%

Provider Discounts Other Savings Plan Pays Patient Liability 0.22610095544827524 7.5434116343027435E-2 0.37084205972013379 0.32762286848856353 image1.jpeg

File details come from the government source that posted it. Updated Jan 8, 2026.