Preventive dental care utilization through private insurance in Saudi Arabia: a nationwide retrospective cohort study using claims data

Dental expenditures are significant, and understanding the contribution of private insurance in minimizing the burden of dental diseases through optimal coverage for primary preventive services could maximize the value of private insurance. Thus, the main objective of this study is to estimate the utilization of three preventive dental services (annual dental examination, topical fluoride, and pit and fissure sealants) through private health insurance. This study was based on secondary data obtained from NPHIES database, which utilizes the Australian Dental Association (ADA) coding system. Children below the age of 18 years who were enrolled in private health insurance in 2023 were included in this study. The study focuses on the utilization of three dental services: dental examination (ADA codes: 011, 012, 013), topical fluoride (ADA codes 121 and 123), and pit and fissure sealant (ADA code: 161). The dataset included 2,195,105 children, with a mean enrollment of 204.88 days. Of those, only 8,311 children had approved or partially approved claims for dental examination, 6,470 for topical fluoride, and 516 (aged 6 years and over) for pit and fissure sealants. The corresponding rates of approved or partially approved claims were 86.80 per 10,000 person-years for dental examination, 53.50 for topical fluoride, and 6.83 for pit and fissure sealants. This study provides the first nationwide estimates of preventive dental care utilization through private health insurance in Saudi Arabia, which were found to be low across all three services examined. The findings highlight the need for regulatory and/or voluntary tools to maximize the role of private health insurance in delivering value-based dental care.