A comparative analysis of public and private dental benefit payer types for the provision and outcomes of root canal therapy on permanent teeth of children and adolescents in Massachusetts

(D3310 for anterior, D3320 for premolar, D3330 for molar) for the first treatment each patient received are reported in Table 3. Amounts allowed and paid by the insurer were significantly higher for those privately insured, regardless of tooth type (P

^, 

^, ,

^,

However, differences in the dental procedure mix for children and adolescents are prevalent; public-payer beneficiaries are more likely to undergo a higher share of therapeutic dental services, including endodontic treatment.

^,

^,

Our findings support those of investigators reporting that pediatric public-payer beneficiaries receive more endodontic treatment, including root canal therapy, than their counterparts with private dental coverage.

^,

^,

code that identifies this procedure does not include tooth type (that is, anterior, premolar, or molar), as is done for endodontic treatments. Without the tooth number, there was too high a risk that a downstream, unrelated tooth extraction may be incorrectly associated with the initial root canal therapy. Another factor potentially limiting the generalizability of our findings is that we have included data from only 1 state, Massachusetts. However, the findings for public-payer (Medicaid, CHIP) beneficiaries in our study were comparable with findings from a cohort of pediatric Medicaid beneficiaries from New York.

To our knowledge, a comparable study does not yet exist for a cohort of privately insured children. Second, as in all studies using dental claims data, the initial diagnosis for the treated teeth could not be determined due to the nonclinical nature of the administrative data and the absence of diagnostic codes in dentistry. This is particularly relevant to our study, as endodontic diagnosis is known to be associated with endodontic treatment outcomes.

^,

Despite these limitations, our study results provide insights regarding access to oral health care for children with public or private dental insurance in the Commonwealth of Massachusetts related to the prevalence of endodontic treatment and access to dental care providers and treatment settings.

^,

Realized disparities in procedural outcomes of root canal therapy according to payer type may also be attributable to differences in treatment setting or dentist provider types. In previous studies using similar methodology, root canal therapies performed by endodontists have been associated with improved outcomes.

^,

It was difficult to make this distinction in our study, as payer type and treatment setting or provider type were so closely associated (P

Our findings, therefore, suggest that endodontists may be more likely to treat children requiring root canal therapy than other dental care providers. Nationally, 43% of all dentists, 73% of pediatric dentists, and only 28% of endodontists, participate in Medicaid for child dental services.

In our study, none of the root canal therapy procedure claims for publicly insured children were associated with a provider specialty code for an endodontist as an individual dental care provider; however, it is possible that when treated in a facility setting, an endodontist was the provider. Facilities (clinics, centers, hospitals) are likely to be dental schools or federally qualified health centers and may employ endodontists or have postgraduate trainees specializing in endodontics as providers. When these facts are considered, one could question whether access to endodontic treatment is limited for pediatric patients enrolled in public insurance.

^, 

^, 

^, 

^, 

^, 

The findings of our study highlighted differences in both allowed and paid amounts for root canal therapy procedure claims billed by insurers, with the amounts allowed and paid by private payers higher than those by public payers. In Massachusetts in 2017, Medicaid reimbursement as a percentage of private insurance reimbursements for diagnostic and preventative dental services was 74%.

We found that the reimbursement percentage was higher for the specific endodontic procedure of root canal therapy on premolars and molars. This may be due to the fact that endodontic treatment performed on premolars and molars generally have higher levels of case difficulty. In the same year (2017) in Massachusetts, 51% of dentists were enrolled as Medicaid providers, but only 26% of Massachusetts dentists had seen Medicaid patients in the past year.

Future research aiming to increase understanding of dentists’ Medicaid participation, particularly for the provision of endodontic services to pediatric populations, will help inform strategies for increasing access to endodontic care for Medicaid enrollees.

^,