Insurance Survey Does your practice hold ‘Out of Network” Status, “ In Network” Status, or a combination ?*If your practice holds mostly “ Out of Network” status, what are the reason(s) you may be looking to join various plans? What plans are you considering?*How many locations do you have?*How many Dental Providers do you have on staff?*Have you increased your office fees in the past 18 months?*YesNoHave you successfully negotiated any PPO fee increases in the last 18 months?*YesNoIf Yes, with which insurance groups?*Enter Your estimated Annual Gross Revenue [ total production before expenses ]*If your practice(s) holds "In Network" status, what insurance groups do you have “direct” contracts with?*ADN, Aetna, Ameritas, Assurant/DHA, BCBS, Careington, Cigna, Connection Dental, Delta Dental,DNOA, Guardian, Humana, Metlife, Prinicipal, United Concorida, Unicare/Anthum. Which of the following 3rd party payor’s is/are your practice(s) in network with: Dentemax, Careington, United Concordia, Connection Dental, DNOA, Zelis or none?*What status do the provider(s) hold with Delta Dental?*Are you aware of what portion of your practice is participating with each dental benefit group? If yes, what are the top 5 groups your patients mostly participate with?What is the practices “active” patient count [ patients seen in the last 18 months?*Select any specialty types that participate with PPO at your practice(s)* Orthodontist Pedodontist Prosthodontist Endodontist Oral Surgeon Periodontist In the fields below, enter in your Practice’s Standard Fees [UCR] for each procedure postedD0120 - EvalD0274 - BitewingD1110 - Adult ProphyD2392 - Composite 2 Surface D4342 - SRP 3 surfaces or lessD4341 - SRP more than 3 surfacesD2740 - Ceramic Crown Contact InformationName* First Last Name of Practice*Position You Hold*Email* Phone*Best Day to CallBest Time to CallEmailThis field is for validation purposes and should be left unchanged.