Dental billing runs on different rules from medical billing: a different code set, a different claim form, annual maximums that reset every January and frequency limits that decide whether a cleaning pays at all. Our dental billing services take the insurance side of a dental office off the front desk, from the benefit check before the appointment to the last patient balance, working inside the practice management system you already use.
What our dental billing services cover
Every claim is built from the clinical note, not the schedule. Codes are checked against the chart and the tooth and surface numbers, x-rays and perio charts are attached where the plan requires them, and the claim goes out electronically on the day of service. Payments are posted line by line, so a downgrade or a partial payment is caught the day it arrives instead of in the next aging report. Unpaid claims are worked by plan and by age, and patient balances are statemented under your office policy through our patient billing team.
CDT coding that matches the chart
Dental procedures are reported with CDT codes, which the American Dental Association revises every January. A periodic evaluation is D0120 and a comprehensive evaluation is D0150, adult prophylaxis is D1110 and periodontal maintenance is D4910. The common coding errors are predictable: billing D1110 for a patient whose history calls for D4910, or reporting scaling and root planing as D4341 when only one to three teeth in the quadrant qualify for D4342. Each one is either a denial or a refund request in an audit, so codes are checked before the claim leaves.
Benefits, frequencies and pre-determinations
Most dental denials are decided before the patient sits down. Plans limit how often a service pays, such as two cleanings or one set of bitewings (D0274) a year, cap benefits with an annual maximum, apply waiting periods to major work and exclude teeth missing before coverage began. A full benefit breakdown is run before the visit, through the same process as our eligibility verification, and recorded where the front desk can see it. Crowns (D2740), implants and periodontal therapy go out as pre-determinations with x-rays and a narrative, so the treatment plan conversation uses the plan's own estimate.
When medical insurance pays first
Some dental work belongs on a medical claim. Extractions related to trauma, biopsies, treatment of infections, and oral appliances for obstructive sleep apnea (E0486) are often covered by the patient's medical plan, billed with CPT and ICD-10-CM codes on the CMS-1500. Coordinating the two plans has its own rules, and some plans will not process their share until the other plan has issued a determination. Medicare covers dental care only when it is linked to covered medical treatment, so for most Medicare patients the dental plan or the patient remains responsible. We decide which plan is primary before the claim is built rather than after the first rejection.
Working dental denials and downgrades
A dental remittance uses the same adjustment codes as a medical one. CO-119 means the annual maximum has been reached, CO-29 means the claim arrived after the filing limit and CO-16 means something was missing, usually an x-ray, a narrative or a tooth number. Each has its own fix, and our denial management process works them by code: a missing attachment is resubmitted within days, a frequency denial is checked against the history the plan has on file, and an alternate benefit downgrade is posted to the patient with the explanation already written.
Getting started
We start with a free review of a month of dental remittances and your outstanding claims, and send back a written list of what is unpaid, why, and what can still be recovered. Onboarding happens inside your existing system and nothing is migrated. Offices that also need help on the phones and the schedule can add a virtual medical assistant for benefit checks and recall. Request the free billing audit or see pricing to compare the options.
What Is Included
- CDT coding checked against the chart and tooth numbers
- Benefit breakdowns with frequency limits before the visit
- Pre-determinations for crowns, implants and periodontal work
- Narratives, x-rays and perio charts attached to every claim
- Medical cross-coding on the CMS-1500 when medical pays first
- Denial, downgrade and patient balance follow-up
| Dental code set | The Code on Dental Procedures and Nomenclature (CDT) is the HIPAA standard code set for dental services on electronic claimsSource: eCFR, 45 CFR 162.1002 |
|---|---|
| Medicare and dental care | Medicare Part B covers dental services only in limited situations where the dental work is inextricably linked to covered medical treatmentSource: CMS, Medicare Dental Coverage |
Dental Billing Services: Common Questions
Yes. Most claims go to the dental plan on the ADA form with CDT codes, but oral surgery, trauma, biopsies and sleep apnea appliances often belong on the CMS-1500 with CPT and ICD-10-CM codes to the medical plan first. We check which plan is primary for the procedure before the claim is built.
We work inside the dental practice management system you already use, under logins you issue, so the ledger, the imaging and the claim history stay in one place. Nothing is migrated, and your front desk keeps seeing the same patient balances we post.
Many dental plans carry an alternate benefit clause that pays a covered procedure at the rate of a cheaper alternative, such as a posterior composite paid as an amalgam. The claim is paid, but the patient owes more. Checking the clause in the benefit breakdown lets the front desk tell the patient before the filling, not after.
Yes. Crowns, bridges, implants, scaling and root planing and most major work go out as pre-determinations with the x-rays, perio charting and narrative the plan asks for, and we follow up until the estimate comes back so the treatment plan conversation uses real numbers.
As a percentage of collections or a flat monthly fee, depending on claim volume and how much of the front-office work you want covered. The quote names what is included. See the pricing page or request a free billing audit to scope it.