Short Description
The highest amount a dental insurance plan will reimburse for a specific procedure, based on the provider’s contracted fee schedule.
Long Description
The Maximum Plan Allowance (MPA) is the highest amount that an insurance company will pay for a covered dental service, regardless of the actual fee charged by the dentist. If the dentist’s fee is higher than the MPA, the patient is responsible for paying the difference (balance billing).
MPA amounts vary based on:
Procedure type (cleanings, fillings, crowns, etc.)
Network status (in-network vs. out-of-network)
Geographic location (regional cost differences)
Patients should check their MPA limits to understand their financial responsibility before treatment, especially when seeking care from out-of-network providers who may charge above the allowed amount.