Full-Arch Cases: The Card-Fee Math That Makes a 1% Rail Obvious

Every dental practice already knows card fees are a cost of doing business. What's easy to miss is how differently that cost behaves on a $150 filling versus a $20,000 full-arch case — the percentage is the same, but the dollars attached to it are not. This piece runs the actual math on full-arch and All-on-4/All-on-X cases specifically, case size by case size, and shows where a lower-cost rail like DDSCrypto changes the number most.

What payment options exist for an All-on-4 or full-arch case today?

Most practices offering full-arch implant work already support several ways to collect a $15,000-plus balance:

• Cash or check — no processing fee, but slower for the patient to arrange and less convenient at checkout.
• Credit or debit card — fast and familiar, but priced as a percentage of the transaction, which is where this article's math starts.
• Third-party patient financing (installment plans through outside lenders) — spreads the patient's payment over time, typically at a cost the practice negotiates separately from card processing.†
• A crypto-to-USD rail like DDSCrypto — patients pay in BTC, ETH, SOL, USDC, or USDT; the rate locks the moment checkout starts, and the practice receives same-day USD settlement without ever holding crypto or touching a wallet.†

None of these options are mutually exclusive. The question this piece answers is narrower: on the card-vs-crypto comparison specifically, how much is actually at stake on a case this size?

Why do card fees matter so much more on a $15,000-plus case?

Processing fees are priced as a percentage, not a flat amount. A 3.53% effective rate on a $150 payment is about $5.30 — easy to not think about. The same 3.53% on a $20,000 full-arch payment is $706 — much harder to ignore once it's isolated as its own line.† Full-arch cases concentrate a practice's highest-value transactions into single payments, so the fee percentage that quietly disappears into routine hygiene visits shows up as a very visible number on case day.

That's also why full-arch cases are the natural place to start when a practice is evaluating whether its card mix is costing more than it should — see the broader breakdown in why the average practice pays 3.53% instead of the "2.9%" a terminal often quotes.

What does the fee gap actually cost, case by case?

Using the average dental blended card rate of about 3.53% against a ~1% rail like DDSCrypto, here's how the dollar gap scales across typical full-arch case sizes:†

Case size	Card fees at 3.53%†	DDSCrypto at ~1%†	Estimated savings per case†
$15,000	~$530	~$150	~$380
$20,000	~$706	~$200	~$506
$25,000	~$883	~$250	~$633
$30,000	~$1,059	~$300	~$759
$35,000	~$1,236	~$350	~$886
$40,000	~$1,412	~$400	~$1,012

The pattern is straightforward: every $5,000 of case fee adds roughly $125–$127 of savings between the two rails, because the gap is a fixed 2.53 percentage points applied to a bigger number each time.† For cases at the lower end of full-arch pricing, the savings land closer to $400–$500; for larger or bilateral cases, they cross $1,000 per patient.†

How does that compare to just surcharging the patient instead?

Some practices respond to card costs by adding a surcharge at checkout, passing part or all of the fee to the patient. That's generally permitted subject to state rules, card-network limits, and disclosure requirements†, but it comes with a cost that doesn't show up on any fee statement: surveys cited in industry research put 55–75% of patients as less likely to return to a business that surcharges. On a full-arch case — where the patient relationship typically continues through adjustments, follow-up visits, and referrals for years — that's a materially different tradeoff than it would be for a one-time retail purchase. A surcharge can recover the fee on paper; it can also cost more in retention and referrals than it saves in processing.†

What about chargeback risk on a case this size?

Card chargebacks carry a flat processing fee of roughly $15–$50 per incident regardless of the ticket size.† On a routine visit, that's a minor annoyance. On a $20,000 full-arch case, the fee itself is the same $15–$50 — but the underlying dispute can put the entire case payment at risk while it's contested, which is a very different exposure than losing a $150 hygiene fee. Crypto payments settle irreversibly once confirmed, so that dispute path doesn't exist on the portion of a case paid through a rail like DDSCrypto — the practice can still issue a voluntary refund, but a patient can't claw the payment back through their bank the way they can with a card. For more on how that difference plays out across a practice's full patient mix, see what chargebacks actually cost a dental practice, and what running a rail with none looks like.

Does the rate-lock actually hold at this ticket size?

Yes — the rate-lock mechanism doesn't change based on transaction size. The exchange rate is locked the moment a patient starts the crypto payment, the conversion happens on confirmation, and the practice's USD settlement amount is fixed at that locked rate regardless of what BTC, ETH, SOL, or the relevant stablecoin does afterward.† Because the practice never holds the crypto itself — DDSCrypto handles the conversion and settles USD to the practice's existing bank account the same day — a $20,000 case carries no more market-movement exposure for the practice than a $200 one.† Settlement lands same-day, compared with the next-business-day settlement offered by some competing crypto processors such as BitPay.†

Does adding a lower-cost rail mean giving up cards or financing?

No. Practices generally keep accepting cards and third-party financing alongside a rail like DDSCrypto rather than replacing anything. In practice, it tends to get offered as one more checkout option and used most often for exactly the case sizes this article is about — implants, full-arch and All-on-4/All-on-X work, and other large treatment-plan payments where the dollar gap between rails is largest. Setup connects to a bank account the practice already has; there's no wallet to manage and no crypto balance to carry on the practice's side.† The full mechanics — how the rate-lock, conversion, and same-day settlement actually work, plus onboarding — are covered in the pillar guide on accepting cryptocurrency at a dental practice.

What does this look like across a typical full-arch caseload?

A single case's savings look meaningful on their own — $500 to $1,000-plus is real money to a practice's margin on that patient. Multiply it across a caseload and it compounds quickly: a practice completing even one full-arch case a month at the $20,000–$25,000 range would be looking at roughly $500–$630 saved per case, or $6,000–$7,500 a year, just on that one case type — separate from whatever a practice is already saving on its routine card volume.† Practices doing more full-arch or implant volume, or seeing higher average case fees, scale that further in direct proportion to the table above.

Getting started

The math here isn't complicated, and that's the point: on a $15,000–$40,000 case, a 2.53-percentage-point gap between a 3.53% card rate and a ~1% rail isn't a rounding error — it's $380 to $1,000-plus per patient, predictably, every time.† A practice doesn't need to change how it treats patients or overhaul its front-desk workflow to capture that gap; it needs a way to offer the lower-cost option at checkout for the cases where it matters most.

For current DDSCrypto rates and how they apply to case-size volume, see pricing. For the full breakdown of where the 3.53% figure comes from across a practice's total card volume, read the itemized $19,000-a-year fee breakdown, or browse more on the blog.

DDSCrypto is a payment processor for dental practices — not a cryptocurrency, and unrelated to Dentacoin (DCN), a separate 2017 token.

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† Figures throughout this article are modeled averages and illustrative estimates based on typical full-arch/All-on-4 case pricing ranges, the average dental blended card rate of 3.53%, and DDSCrypto's approximate ~1% rail rate; actual card mix, processor markup, financing costs, chargeback frequency, and case pricing vary by practice, patient, and region. Validate against your own merchant statements and case fee schedule before making decisions. Pending counsel review; not legal or tax advice.