Why dental practices get overcharged
Dental is one of the highest-ticket consumer services in the country. The average dental practice processes 60% of its card volume on transactions over $500 — and that's where merchant services makes its money. Specifically:
- Premium rewards card concentration. Patients use their best cards for $1,000+ procedures to bank points. Premium rewards interchange is the highest in the system — 2.10% + 10¢ or more. On tiered pricing, every one of those lands in Non-Qualified.
- Recurring billing for treatment plans. Card-on-file payment plans for orthodontics, implants, cosmetic work. Card-not-present interchange is higher than card-present, and processors charge more on top.
- CareCredit and Sunbit. Healthcare-specific financing has its own pricing terms, often outside your main processor — but they should be evaluated together to understand true cost.
- Insurance refund volume. When you refund a patient because their insurance covered more than expected, some processors don't refund the interchange — you pay it twice.
What we look for in a dental statement
- Tiered pricing on high-ticket transactions — single biggest overpayment driver. A $2,000 crown on tiered pricing might cost $74 in fees; on Interchange Plus, it's $46.
- Refund interchange recovery — modern interchange tables let processors refund the interchange portion when you refund a transaction. Some processors keep it. We check.
- Treatment-plan card-on-file rates — recurring billing should be priced as recurring CNP, not standard CNP. Difference is 0.10% – 0.30%.
- Equipment leases on countertop terminals — particularly common in dental offices.
- PCI Non-Compliance fees — many dental practices haven't completed their SAQ and quietly pay $25 – $99/month.
- HSA/FSA card handling — should be processed normally but the merchant category matters for IRS Section 213(d) eligibility.
A typical dental practice audit
Real example (anonymized): a two-doctor practice in California, $84,000/month in card volume, average ticket $470.
| Current cost | Optimized cost | Annual savings |
|---|---|---|
| Tiered, effective rate 3.18% | Interchange Plus, effective rate 2.31% | $8,770 |
| $55/month statement fees | $0 | $660 |
| $59/month PCI program | $0 (self-attest) | $708 |
| Terminal lease ($87/mo) | Owned ($350 one-time) | $695 yr 1, $1,044 yr 2+ |
| Total annual savings (year 2+): | $11,182 | |
What we won't tell you
- That CareCredit is bad. It's not — for patients who need financing, it's often the right product. We just help you evaluate its true cost alongside your regular processing.
- That you have to leave Dentrix / OpenDental / Eaglesoft. Practice management software stays. Only the card processing changes.
FAQ — dental practices
Do I have to integrate with my practice management software?
Most modern processors integrate with Dentrix, OpenDental, Eaglesoft, Curve, and the major web-based PMS platforms. We confirm integration availability before recommending any switch.
What about HIPAA?
Payment processing doesn't touch PHI directly — only patient names and amounts. But your processor should have a BAA available if you store any clinical details alongside payment records. We check.
Can I keep CareCredit?
Yes. CareCredit is a separate financing product, not your main processor. They coexist with any merchant account.