Is my dentist scamming me?

Hi,

I am supposed to get a new crown placed on my implant soon. So I need to get a custom abutment and a new crown. My dentist ran my insurance for pre-approval and this is what shows up on the Delta Dental CA PPO.
In both cases, Delta dental has a Contract benefit level of 60%.

Entry 1 : (D6057) Custom fabricated abutment – includes placement Tooth: 18

Submitted fee estimate: $1,332.00

Accepted fee estimate: $836.00

Delta Dental pay estimate: $501.60

Your estimated cost: $334.40

Entry 2: (D6058) Abutment supported porcelain/ceramic crown Tooth: 18

Submitted fee estimate: $1,932.00

Accepted fee estimate: $1,623.00

Delta Dental pay estimate: $564.20

Your estimated cost: $1,058.80

In first entry the math correctly checks out where $836.00 * 60% = $501.6. So I pay $334.40 and delta pays $501.6.

In second entry the math seems to be wrong. The accepted fee is $1623, and delta should have paid $1623 * 60% = $973.8. After doing some research, it seems that the insurance has a hidden Maximum contract allowance which the dentist is supposed to charge. The dentists are always free to charge whatever they want, but as long as they are in network, they are supposed to charge the Maximum contract allowance.

So based on this data, I believe that the Accepted fee should have been something like $940 in reality and not the $1623 the dentist is charging me? Can someone let me know if my understanding is correct? Is my dentist scamming me?

submitted by /u/TheDictator90
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