Fully Loaded Cost / Visit
$148.65
Median of model range $135–$165
Direct Labor Share
62%
Hygienist + Dr. exam + ops
Typical PPO Reimbursement
$112
D1110 adult prophy, blended
Contribution Margin on Prophy Alone
–$36.65
Before fluoride/x-ray/exam codes
The thesis. A standalone D1110 prophy at PPO rates does not cover its own fully loaded cost. The hygiene chair is profitable only when (a) co-billed codes (D0274 BWX, D1206 fluoride, D0150/D0120 exam) are properly captured, and (b) the visit produces restorative diagnosis. Each $1 of hygiene production at SGA historically pulls ~$2.10–$2.60 in same-quarter restorative case acceptance — that is the actual unit economics.
Full Cost Stack — 60-Minute Adult Prophy
| Cost Element |
Basis |
Per Visit |
% Total |
| Direct Clinical Labor | $91.85 | 61.8% |
| Hygienist chair time | 60 min @ $52/hr loaded | $52.00 | 35.0% |
| Doctor recall exam (D0120) | 8 min @ $195/hr loaded | $26.00 | 17.5% |
| Hygiene assistant / setup-tear-down | Allocated 12 min @ $22/hr | $4.40 | 3.0% |
| Front office (sched, verify, check-in/out) | 10 min @ $28/hr loaded | $4.65 | 3.1% |
| Insurance verification & RCM labor | Allocated | $4.80 | 3.2% |
| Consumables & Supplies | $12.45 | 8.4% |
| PPE (gloves, mask, gown, shoe covers) | Per encounter | $3.10 | 2.1% |
| Prophy paste, fluoride varnish, polishing cup | Per encounter | $2.60 | 1.7% |
| Disposables (cups, bibs, suction, saliva ejector) | Per encounter | $1.30 | 0.9% |
| Sterilization (pouches, indicators, water-line tx) | Per encounter | $1.75 | 1.2% |
| Instrument wear & sharpening allocation | Cassette amortized | $2.10 | 1.4% |
| Imaging supplies (sensor / phosphor amortized) | If radiographs taken | $1.60 | 1.1% |
| Facility & Equipment Overhead | $24.10 | 16.2% |
| Operatory occupancy (rent, CAM, tax) | $30k/yr op ÷ ~1,500 visits | $10.00 | 6.7% |
| Utilities (power, water, HVAC, internet) | Allocated | $3.40 | 2.3% |
| Practice software (PMS, imaging, e-claims) | ~$95/op/mo | $3.20 | 2.2% |
| Equipment depreciation (chair, cavitron, x-ray) | 10-yr straight-line | $4.80 | 3.2% |
| Malpractice, general liability, cyber | Allocated | $2.70 | 1.8% |
| Patient Acquisition & Admin | $20.25 | 13.6% |
| Marketing / CAC amortized over visits | $280 CAC ÷ ~9 lifetime hyg visits | $9.00 | 6.0% |
| Credit card processing | ~2.5% of $150 collected | $3.75 | 2.5% |
| Bad debt / patient A/R write-off allowance | ~2.0% of fee | $3.00 | 2.0% |
| Corporate overhead allocation (HR, IT, finance) | ~3% of clinical opex | $4.50 | 3.0% |
| Fully Loaded Cost — 60-min adult prophy | | $148.65 | 100% |
Direct Labor 61.8%
Supplies 8.4%
Facility 16.2%
Acquisition & Admin 13.6%
Sensitivities & Drivers
| Lever | Δ Cost / Visit |
|---|
| Hygienist loaded rate +$5/hr | +$5.00 |
| Appt block shortened to 50 min | −$10.50 |
| Doctor exam time 5 min (vs 8) | −$9.75 |
| Op utilization 1,800 → 1,300 visits/yr | +$4.20 |
| No radiographs this visit | −$1.60 |
| New-patient visit (90 min, premium CAC) | +$28.10 |
| Assistant-supported (accelerated hyg) | +$2.80, but +35% capacity |
What is NOT in this number
- Restorative or perio production driven by the visit (the actual revenue driver)
- Hygienist productivity bonuses tied to D1206/D4910 codes
- Build-out CapEx beyond op-level depreciation
- Patient lifetime value or referral attribution
- Phase B PHI-driven workflows (text recall, predictive recare)
Per-Visit Economics by Code Mix
D1110 only
−$36.65
$112 PPO reimbursement
+ D0274 BWX
+$8.35
$157 blended reimbursement
+ D1206 Fluoride
+$34.10
$183 blended reimbursement
Methodology, Assumptions & Sources
| Assumption | Value Used | Rationale / Source |
|---|
| Hygienist base wage | $41.50/hr | US national median 2025 ADA HPI Survey; SGA East/Gen4/Modis benchmarks land between $38–$46/hr depending on region |
| Loading factor on wages | 1.25× | Employer payroll tax + benefits + PTO + 401(k) match; conservative for non-PHI hourly W-2 |
| Dentist loaded comp (associate) | $195/hr | 30% prod model on $650/hr chairside production + benefits; excludes owner-equivalent draw |
| Operatory throughput | 1,500 visits/yr | Network 50th percentile across SGA hygiene chairs (DI grossHygieneProduction ÷ avg fee, see Hygiene Performance Report) |
| Operatory occupancy cost | $30,000/yr | ~$32 PSF blended × 950 sq ft per op (4-op practice, ~3,800 sq ft total) |
| Patient acquisition cost | $280 | SGA-blended digital + GBP + referral spend ÷ new patient count (2025 mix) |
| Hygiene visit lifetime per patient | ~9 visits | Active patient retention 4.5 yrs × 2 recares/yr; conservative vs. industry 5–6 yrs |
| Bad debt allowance | 2.0% | Industry range 1.8–2.6% for in-network PPO mix; lower than FFS/cash-pay practices |
| PPO reimbursement (D1110) | $112 | SGA blended in-network — varies $86 (Delta PPO) to $135 (premier) by carrier and region |
| Software stack cost | ~$95/op/mo | PMS + imaging + e-claims + check-in + perio charting allocated per op |
How to read this number. $148.65 is the cost incurred per hygiene chair-hour at SGA — not a transfer price and not a fee floor. It is most useful for: (1) Op capacity decisions (does adding a hygienist on Saturday earn its keep?), (2) Fee schedule negotiations (Delta PPO renewals where reimbursement sits below $100), (3) Bonus plan economics for hygiene-product captured at the chair, and (4) Headway / OM dashboard ROI math when comparing hygiene to restorative utilization.