The mix of expenditures’ sources for dental services has also undergone major shifts (Figure 1). In 1960, out-of-pocket expenditures accounted for more than 97 percent of dental expenditures. Insurance as a source of dental expenditures increased rapidly through the 1970s, ’80s, and early ’90s, peaking at 52.3 percent of dental expenditures in 1996. Since then, insurance as a source of expenditures has decreased slowly. Government sources of dental expenditures were virtually nonexistent in 1960, accounting for less than 1 percent of all expenditures. Government expenditures have risen slowly since then. The profile of expenditures for dental services in 2002 was 49.6 percent from insurance, 43.9 percent from out-of-pocket, and 6.5 percent from government sources. In contrast, government sources accounted for 33.8 percent of expenditures for physician and clinical services in 2002. The U.S. Centers for Medicare and Medicaid Services predicts insurance, as a source of expenditures, will continue its slow decline to 47.9 percent in 2013. They also estimate out-of-pocket expenditures to essentially remain constant at about 44.2 percent of expenditures and for government sources to increase to 7.9 percent of all dental expenditures by 2013. This projection estimates government expenditures for dental services doubling by 2013 to approximately $10 billion. Historically, government expenditures for dental services have not increased at this rate.