The Secret to Higher Dental Claim Reimbursements Most Practices Miss

Dental claim reimbursements are a huge source of revenue for practices. In fact, insurance payments account for most of the income for dental practices.

But the issue is that many practices write off a great share of these payments due to claim denials. Plus, underpayments against dental claims also lead to revenue losses for practices.

Most practice staff don’t catch up on this. They’re occupied with scheduling patient appointments, managing practice supplies, and providing dental care.

However, you can manage this and recover thousands of dollars with smart strategies, such as investing in expert dental RCM services.

Want to unlock the secret to higher reimbursements? Let’s discuss.

How to Maximize Dental Claim Reimbursements?

Let’s reveal secrets that help you know how to increase dental insurance reimbursements for a smooth revenue cycle.

Negotiate Reimbursement Rates with Payers

Dental credentialing is the first step to complete dental claim reimbursements for your practice. It’s when you enroll with payers, joining their insurance networks, and becoming eligible to treat insured patients.

This is where you can negotiate reimbursement rates with payers and set up rates that you’re paid for the duration of your contract.

If you want to set rates that cover your practice expenses, like lab supplies, rental charges, staff wages, and utilities, and offer you some profits, prepare a complete list of your expenses with documents, like invoices of staff salaries and bills.

Also, share your area’s UCR (usual and customary) rate. It’s the fees for most practices in your area, and it supports your argument for the desired fee, which you can easily find out by:

• Checking websites for dental practices
• Consulting state dental associations for information
• Contacting practices via phone

And, if you’re seeing a high number of insured patients for that payer, share the data on patient volume by pulling it from your practice management system. It justifies that you’ve provided high-quality care to their members.

Based on that, propose the reimbursement rates for the treatments. You’ll be writing off some amount as a contractual adjustment (which means that you’ll be charging patients less than your routine dental fee), and you can’t charge patients above that for covered services, so it’s fair to negotiate rates that easily:

• Cover your expenses
• Justify your quality treatment for high patient volume
• Match your UCR rates

Make sure you don’t miss this step in your insurance contracts. If you miss it, you’ll have to accept payers’ fee throughout the contract, whether it lasts 3 or 5 years, and it may be hard to change, regardless of a rise in inflation.

Pro tip: Leverage re-credentialing when your contract with a payer is set to expire. It’s the time when a payer tries its best to retain you, and you can convince them to set rates for dental claim reimbursements and favorable contract terms.

Check and Fix Claim Denial Reasons

You can solve much of the problem if you find out why payers deny your claims, correct the issue, and prevent it in the future.

Denial reasons are available in an explanation of benefits statement, which payers send to you after receiving and reviewing your claims. 

There is a section of “Remark Code” or “Reason Code”, where they mention a short alphanumeric code, which helps you find the denial reason. You can check the payers’ list of remark codes, which explains what each denial code means and why they’ve denied the claim.

Let’s check the common denial reasons that delay your dental claim reimbursements:

These are some common billing errors, which are easily preventable.

Now, let’s discuss fixes to these errors, so you know how to submit clean dental claims, which get reimbursed fast.

Make Front Desk Process Strong

Most problems start at the front desk, not while billing. If you do that right, you can prevent most of these issues. And for that, you need a strong front office management for your practice.

Now, the process relies on:

• Collecting complete and accurate patient details and insurance information at every visit
• Scanning the front and back sides of insurance cards each time
• Verifying the patient’s insurance eligibility, coverage benefits, limitations, and COB details at every visit
• Communicating patients’ share of treatment costs on time
• Flagging missing information before the patient leaves

If you schedule treatments and proceed with them without these must-haves, you’re likely to receive denials and miss your dental claim reimbursements.

Pro tip: Use real-time eligibility verification instead of verifying details upfront, as patient coverage can change anytime. Verifying details at the time of service helps you know what payers cover and what patients pay, so you can share accurate cost estimates with patients and submit clean claims to payers.

Follow Payer Requirements for Claim Submission

You can maximize your dental claim reimbursements if you know and comply with payer policies and reimbursement rules.

Check their payer manuals, which clearly mention the list of codes and procedures they approve and reimburse. They also share a list of documents they require for each procedure to prove its necessity.

So, read through these manuals and implement the payer policies in your billing processes.

Use CDT Codes that Payers Reimburse

Payers pick up the CDT codes by following ADA’s updates. They may use all of them or add select codes in their payer manuals to control costs and share benefits across insurance members.

They may bundle some codes by merging diagnosis and check-up into a single treatment code and reimburse them. 

It’s important to stay updated with ADA’s latest changes to CDT codes, such as the 2026 update, and follow the payer list of codes. Use the information to choose codes for procedures and maintain CDT coding accuracy for dental reimbursements.

Example: You perform a comprehensive oral evaluation (D0150) on a patient’s tooth and find a cavity requiring a one-surface resin restoration (D2391). Some payers bundle the evaluation into the main restoration. They reimburse only the treatment, not the check-up. If you don’t submit the correct code, the payer may deny your claim or pay less.

Attach Complete Documents with Dental Claims

Fulfill payer-specific documentation requirements by attaching the documents for a certain dental procedure, like:

• Clinical narratives
• Dental radiographs
• Intraoral photos
• Medical necessity letter

Payers require documents for procedures, like bridges, crowns, dentures, implants, and surgical extractions, to prove that the issue is genuine and the patient needs treatment. Even a single cleaning may also require documentation, so make sure to attach documents with all the procedures. After all, strong documentation improves your dental claim reimbursements.

Example: You submit a claim for an anterior root canal (D3310). To justify the procedure, attach clinical notes that explain pulp diagnosis, along with the tooth number, and pre-op and post-op radiographs to check the dental condition before the treatment and improvement after it. (The requirement may vary by payer.) When you attach radiographs, make sure they are in the payer’s required format and file size limit. They may require you to submit in JPG, PNG, or PDF file formats, or within a maximum file limit of 300KB.

Obtain Pre-Authorization for Certain Procedures

Payers want to control costs for high-risk or complex treatments, so they expect you to prove that the treatment is genuine for dental claim reimbursements.

Some procedures require pre-authorization, which you need to follow. Payer manuals have a list of these treatments, and you must check them and obtain the payer’s approval for these claims.

If you submit a claim without pre-authorization when the payer has required it, the claim will be denied.

So, to submit a pre-authorization request, send a letter to the payer in which you justify the necessity for the treatment, and also attach the documents that prove your statements. If it convinces the payer and you receive the approval, get the pre-authorization number and submit the claim with it.

Submit Claims in the Correct COB Order

When your patient has dual insurance coverage, make sure you correctly apply the coordination of benefits. You can find these details in the patient’s insurance eligibility verification. It mentions the primary and secondary payer in the correct order.

But still confirm it with the payer, and then submit the claims by following the order to boost your dental claim reimbursements.

First, submit the primary claim by following the regular claim submission process and mentioning that it’s the primary claim on your dental claim form. 

An ADA dental claim form features the field number 35 to add remarks, where you can mention that you’re applying COB, and also reference the payer’s coverage details to inform the payer that you’re following the right order.

When the payer reimburses your primary claim and shares its EOB statement, initiate the secondary dental insurance billing process.

Submit the secondary claim by attaching the primary claim’s EOB and clearly mentioning the order in the COB.

Send Claims within the Payer’s Deadline

The payers set time limits to submit a dental claim after the date of service. These may be limited to 30 or 60 days, or may extend to 180 days or even a full year. So, comply with your payer policies.

But the best practice is to send the claim immediately when you perform a service because forgetting to submit the claim on time may delay payments.

When you submit claims early, it makes sure payers clear your dental claim reimbursements faster, so you receive payments on time and manage the dental revenue cycle with a consistent cash flow.

Manage Denied Claims with Timely Appeals

Many practices don’t follow up on claim denials and end up writing off their easily collectible amount.

But remember, claim denials don’t mean the end. You can still recover revenue with smart denial management.

Here are a few dental claim denial management tips you can follow to recover revenue fast:

• Track your claim progress after submitting it to the payer by checking it in the payer portal or contacting a payer representative
• Review your EOB, check the denial code, and check your claim against it
• Make the corrections in your claim form and gather the documents that prove the treatment is valid
• Prepare a professional and respectful appeal letter and request the payer to reconsider the claim
• Attach the corrected claim form and supporting documents to the appeal letter, and submit it
• Submit the appeal within the payer’s defined timeline for receiving appeals after denials
• Follow up on the appeal progress with the payer

If the payer approves your appeals and processes dental claim reimbursements, that’s a win. 

But if it denies your appeal requests, check the mistakes. If there are mistakes, correct them and submit second appeals according to the payer’s timeline. But if you still don’t receive reimbursements, escalate the issue with the company’s insurance supervisor. 

You may also get your appeals checked via peer-to-peer reviews with the insurance company’s dentists.

And, if payers still uphold the decision on your appeals, complain to your state’s insurance department for quick resolution.

Use Electronic Claim Submission

Electronic claim submission is now the new standard for dental insurance billing. While manual claims sent via fax remain in practice, electronic claims are now preferred by payers to receive claims.

And why not? Payers receive these claims very fast. As compared to manual claims, which may take at least 2-3 business days or even more for distant locations, electronic claims are sent immediately via email or the payer portal.

When they receive, review, and approve your claims quickly, it speeds up your dental claim reimbursements.

Reconcile Payments with Fee Schedules

Denials aren’t the only issue that impacts your dental claim reimbursements. Underpayments also affect your payments.

So, when you receive the dental explanation of benefits, don’t just submit payments straight into the patient ledgers.

Match your EOBs with the contracted fee schedules. You’re already writing off some of your regular fees in insurance payments, and you can’t afford further revenue loss.

Make sure that the payments match the fees set in your fee schedules with the payers. If payments are lower, contest that by sending appeals.

To submit an appeal, attach a copy of your dental EOB and fee schedule with the letter to justify that you’re paid less, and politely request the payer to reimburse the correct amount.

If the appeal has strong documentation to justify your request, you’re likely to receive full dental claim reimbursements.

Reduce Accounts Receivable

Accounts receivable management is an important strategy that helps boost your dental claim reimbursements.

Find out your aging claims and implement practices to reduce your outstanding balances and clear maximum payments.

Divide your outstanding payments by aging into 30, 60, or 90-day A/R aging buckets and identify risk. The table below helps explain the difference and action required in each aging bucket:

In most cases, you prioritize older claims with payments stuck for 90+ days. But it may depend on the dollar value. Sometimes, newer claims may have a higher dollar value than older claims, so shift your focus to the high-value amount.

Conduct Billing Audits

With billing audits, you can evaluate your past billing trends to check your revenue cycle performance and see if your dental claim reimbursements are fair for the services rendered.

Audits help you analyze charges and payments across years, months, providers, payers, locations, and fee schedules while identifying coding errors, compliance gaps, unresolved claims, denials, invalid write-offs, and no-response claims to uncover hidden revenue opportunities.

By checking on that, you may find several unpaid claims that you can submit and recover the amount. Plus, you can also find billing errors that have resulted in denials. You can correct your billing processes and submit clean claims that get approved fast.

Automate Claim Submission

Manual submissions are no longer the medium for dental claims in 2026. 

Invest in the latest technology, as AI-powered automation does the job much faster and more efficiently, reducing almost all errors.

So, automate your dental practice revenue cycle management for dental claim reimbursements. You can either integrate your practice management system with a billing software or use an all-in-one platform, which combines and performs all the tasks.

It automates all the processes step-by-step by:

• Scheduling patient appointments and gathering details at check-in
• Verifying the patient’s insurance coverage
• Recording all treatment notes and details
• Using the right procedure code for a treatment
• Attaching all the required documents
• Detecting errors in claim forms via a built-in claim scrubbing software and suggesting corrections
• Sending claims to the payer after corrections via a clearinghouse
• Receiving dental claim reimbursements and processing payments to the patient ledgers

A major benefit of automation is that you can import payer policies via payer portals, which these tools check to prevent claim denials and fix them in advance, which is much easier than managing and rectifying denied claims.

These tools also generate dashboards, which show you performance metrics and suggest corrective actions to improve your workflows. You can customize these tools according to your practice needs and processes.

Some advanced systems go one step further by integrating with cameras for digital imaging to take high-quality intraoral photos required for claims. These systems internally scan the images to see if they comply with payer requirements for claims.

Outsource Your Billing

Submitting claims isn’t an easy task. You don’t have to just send a claim to a payer. It requires many more things, such as:

• Verifying the patient’s insurance
• Checking payer policies for dental claim reimbursements
• Completing all the documents
• Matching codes
• Scrubbing claims before submission

It doesn’t just consume your time. It also increases your overhead as you have to pay huge salaries to billers, and even then, they make mistakes as they’re exhausted from handling many claims throughout the day.

A cost-effective way to reduce your staff’s burden and maximize their productivity is to outsource your dental billing and revenue cycle management to a partner like TransDental, which manages all these tasks.

Dental billing outsourcing benefits include:

• Better and faster results at a price you can easily afford
• Easy integration with your existing practice systems
• Full compliance with payer policies
• Impressive clean claim rate with a proven track record
• Quick and complete dental claim reimbursements
• Regular reports on claim submission progress

Conclusion

Getting faster and complete dental claim reimbursements isn’t just a dream anymore. It’s possible with a smart and proactive approach. Automate your revenue cycle tasks by:

• Using high-end software
• Scanning your claims against payer policies
• Submitting claims that are quickly approved and reimbursed

And, if your staff is overwhelmed with it, partner with an outsourcing company, which handles your claim submission for faster payments and optimized revenue cycle management.

Frequently Asked Questions (FAQs)