Why a dental invoice looks the way it does

What the GOZ is — and what it is not

The Gebührenordnung für Zahnärzte is not a practice's price list but a federal statutory regulation. For every dental service it lays down how that service is described, how many points it counts for and within what range it may be billed. A practice cannot pick and choose these figures — it has to apply them.

The GOZ has been in force since 1 January 1988. Back then a litre of petrol cost about one Mark, and one point was worth 11 Pfennig. On 1 January 2012 the schedule of services was revised: new techniques were added, outdated ones dropped. The point value remained untouched — it was merely converted when the euro was introduced and has stood at 5.62421 cents ever since.

How a fee comes about

The invoice is a simple multiplication of three values:

Points × point value × uplift factor = fee

An example using a service that arises with almost every crown and every inlay — adhesive bonding, GOZ number 2197. It is rated at 130 points:

The first two values are fixed. Only the factor can move — and it is precisely what the rest of this page is about.

The point value: a figure from 1988

The point value is the real sore point. It has never once been raised since the regulation came into force. By way of comparison: wages, rents, energy, materials and laboratory costs have risen considerably since then.

In concrete terms: what cost one euro in 1988 costs around 2.11 euros today. Put differently — the point value today still has about 47 percent of the purchasing power it had when it was introduced. The 2012 revision did not change this either: the Bundesgesundheitsministerium (Federal Ministry of Health) put the increase in fee volume at around six percent at the time — after 23 years without any adjustment at all.

Where the factors come from

The regulator knew that dental work cannot be forced into a single flat price. A root canal treatment on a straight front tooth is something different from the same treatment on a strongly curved molar. That is what the uplift factor is for.

• 1.0 to 2.3 — the usual range. The 2.3-fold rate stands for a treatment of average difficulty that takes an average amount of time.
• 2.3 to 3.5 — only where there are particularities in difficulty, in the time required or in the circumstances of the treatment. These must be justified on the invoice in writing, understandably and comprehensibly, and with reference to your case.
• above 3.5 — no longer within the range of the regulation. Permissible only through an agreement made in writing before the treatment.

Legal framework: § 5 Abs. 1 und 2 GOZ (fee range and assessment), § 10 Abs. 3 GOZ (duty to give reasons), § 2 Abs. 1 bis 3 GOZ (deviating agreement, form, protection in emergencies).

Why agreements above 3.5 are made today

This is where the two lines meet. The factor is not a profit margin — it is the only lever the regulation provides at all. And because the point value has stood still since 1988, this lever now has to take on tasks it was never intended for: not only to reflect the effort involved, but also thirty-eight years of currency depreciation.

This is the heart of it: in today's purchasing power, the 2.3-fold rate of 1988 corresponds to roughly the 4.86-fold rate. Even the maximum rate of the regulation — 3.5 — is in real terms below what the 1.66-fold rate was worth in 1988. For treatments that work with a surgical microscope, navigated implant placement, digital planning, long treatment times or particularly high-quality materials, the range of the regulation is thus simply exhausted.

For precisely this situation, § 2 GOZ provides for the option of agreeing a higher factor. That is not a special arrangement, but the route the regulator itself intended.

What a high factor really means

At this point almost the same question always comes up: if you bill the 7-fold rate — do you then earn seven times as much as from a patient with statutory insurance? The answer surprises most people. No. Usually it is the other way round.

The reason lies in the two catalogues. Statutory health insurance bills according to the Bema, we bill privately according to the GOZ. Both describe the same work — but the GOZ base value is so low that even at the maximum rate of the regulation it often does not come close to the statutory amount. And that statutory amount is defined by law as what is sufficient, appropriate and economical — that is, precisely not a luxury benchmark, but a lower limit (§ 12 Abs. 1 SGB V).

For the check-up the gap is still small. For other services it is dramatic. The table below places 41 corresponding services from the two catalogues side by side — across prophylaxis, fillings, surgery, dentures and orthodontics.

Read the table like this: on the left is the GOZ service with the amount the regulation provides for in the standard case (2.3) and at the maximum (3.5). On the right is what the statutory health insurer pays for the corresponding service. The last column is the factor that would be needed to reach that amount. In not a single one of these 41 comparisons is the maximum rate of the regulation sufficient for that.

All 41 comparisons — the table can be scrolled. Sorted by the required factor, descending.

So if your cost estimate ever shows a factor of 5, 7 or more, that does not mean we earn five or seven times as much. As a rule it means: this service is rated so low in the GOZ of 1988 that only this factor reflects the effort the treatment actually involves.

How such an agreement works

• It is concluded before the treatment, never afterwards.
• It is in writing and appears on a document of its own — not hidden away in a consent form.
• It names the service concerned and the agreed factor.
• It includes a note that reimbursement by an insurer or by Beihilfe may not be made in full.
• It is voluntary. If you would rather not, we discuss a solution within the range of the regulation or a different treatment option.
• Treatment for pain or in an emergency may never be made dependent on such an agreement. § 2 Abs. 3 GOZ expressly prohibits this — you are treated first in any case.
• A practice's own point value may never be agreed. Only the factor is negotiable; the basis of the calculation remains the regulation.

What this means for privately insured patients

Your tariff decides how much you get back — not the practice. The spread is wide: some tariffs reimburse up to the 3.5-fold rate and beyond, others cap at 2.3. Beihilfe offices as a rule reimburse up to 2.3, and up to 3.5 in justified cases.

Our suggestion: ask us for a cost estimate and submit it to your insurer before the treatment. Then you know in advance what your tariff covers — and we can adjust the planning while nothing has been decided yet.

What this means for patients with statutory health insurance

Your statutory health insurer pays for standard care. We bill that directly with them, under a different catalogue — the BEMA. You only come into contact with the GOZ where you decide on something that goes beyond standard care:

• Higher-quality restorations — for example a ceramic filling, an all-ceramic crown or an implant instead of the statutory option. You receive the subsidy from your health insurer; we bill the difference according to the GOZ.
• Services at your request — professional dental cleaning, bleaching, a composite filling in the posterior region.
• Services the statutory catalogue does not contain — for example treatment under a surgical microscope.

In all of these cases you receive a treatment and cost plan or a cost estimate beforehand. Nothing is started before you know what it costs.

Invoice, instalments and reimbursement

Our invoices are handled by BFS health finance, a billing company specialising in the healthcare professions. For you, this changes nothing about the invoice itself — it follows the same fee schedule, with the same item numbers and factors. What changes is what you can do with it afterwards.

• Payment in instalments. You can settle your invoice in instalments — from 25 euros a month and over a term of up to 72 months. This is arranged directly with BFS, online or in the app; the access details are on your invoice. BFS tells you the terms beforehand, and you decide afterwards.
• Free reimbursement service. If your private health insurer or your Beihilfe office rejects the invoice in whole or in part, BFS examines the notice of rejection and draws up a professional counter-statement that you pass on to your insurer. This service is free of charge for you. What is needed for this is the complete written notice of rejection — a description over the telephone is not enough.
• An overview at any time. You can view your invoices and payment status around the clock in the BFS patient portal.

Why the reimbursement service matters particularly to us: with precisely the items this page is about — justified factors above 2.3, agreements under § 2 GOZ — insurers occasionally make reductions using standard text blocks, without examining the individual case. You should not have to stand up to that on your own. The point is that your insurer should in the end pay what it has contractually undertaken to pay.

Billing through BFS requires your written consent — without that consent no data is passed on. You receive it before the treatment together with the other documents. Payment in instalments and the reimbursement service are offered by BFS health finance; the terms apply between you and BFS.

How we handle this

• You receive every plan in writing in advance — with item numbers, factors and amounts.
• We will explain every item to you if you wish. Do ask; it is your money.
• Where an agreement under § 2 GOZ makes sense, we tell you openly why — and you decide at your own pace.
• Where there is a more affordable option that is medically justifiable, we tell you about it.
• With acute pain, treatment comes first. Everything else we discuss afterwards.

Frequently Asked Questions

Sources

• Gebührenordnung für Zahnärzte (GOZ), official text — gesetze-im-internet.de
• Statistisches Bundesamt: consumer price index for Germany, long time series from 1948 — destatis.de
• Statistisches Bundesamt: inflation rate of +2.2 percent in 2025 — destatis.de
• Bundeszahnärztekammer (Federal Dental Association): Gebührenordnung für Zahnärzte — background and statements — bzaek.de
• Bundeszahnärztekammer: statement on the uplift rate under § 5 GOZ — bzaek.de
• BFS health finance: reimbursement service for patients — meinebfs.de
• Zahnärztekammer Nordrhein (Dental Association of Nordrhein): the GOZ for patients — zahnaerztekammernordrhein.de

Figures as of August 2026. The consumer price index refers to the base 2020 = 100 (1988: 57.7, chained via the series for the former West Germany; 2025: 121.9). This page explains how the fee schedule works and does not replace legal or tax advice. Whether your insurer reimburses, and how much, depends solely on your contract.

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