What is Dental Billing and Coding?

Dental billing and coding is the backbone of every dental practice’s revenue cycle. It determines how quickly your claims are processed and how accurate your reimbursements are. However, many practices still struggle. Payer rules are complex and constantly changing, staffing shortages make follow-ups inconsistent, and missing documentation leads to denials.

Whether you’re a dentist, practice manager, or a front desk officer, this guide helps you understand common billing challenges like slow A/R, high denials, or limited billing support, with practical solutions, and key areas within billing and coding you should know, and best practices to excel in dental billing.

So, let’s get started.

Dental Billing and Coding

Dental billing is the process of managing a dental practice’s finances related to claim recoveries from insurance companies against dental procedures. Key steps in this process include:

• Submitting claims
• Posting received payments into accounts
• Collecting patient balances

A major part of billing is dental coding, which explains the treatment provided to insurers via standardized CDT codes, set by the American Dental Association (ADA). The CDT code is entered in a claim submission form. Usually, ADA claim forms are submitted for dental billing, but some insurance companies also use their own claim forms.

Applying the right code with each procedure on a form ensures your claims are submitted accurately, preventing denials, and strengthening your trust with both patients and payers.

Now, let’s have a look at how dental billing and coding impacts your practice revenue.

Impact of Billing and Coding on Practice Revenue

Accurate billing and coding are critical for your practice’s financial health, patient experience, and regulatory compliance. It’s an essential component for any practice’s revenue management strategy.

Let’s discuss how following each procedure the right way or incorrectly affects your practice’s finances. 

Cash Flow

Submitting claims accurately and timely maximize your practice’s earnings regularly. Mistakes or delays in claims can cause weeks or even months of lost income. By checking claims carefully and following up promptly, you can avoid financial slowdowns and ensure stable income to cover staff salaries, office supplies, and other practice expenses.

Patient Experience

Being clear with patients about what insurance covers, what they owe, and how payments work builds trust. When patients understand their financial responsibility, there are fewer misunderstandings or disputes. Clear communication helps patients pay on time, feel confident about their care, strengthens their relationship with your practice, and improves your reputation. 

Patients become your frequent visitors and chances are that a positive word-of-mouth drives more patients towards your dental practice, maximizing your revenue opportunities.

Team Workload

Organized billing processes reduce stress for staff. Fewer claim rejections, resubmissions, or insurance phone calls mean the team can focus on helping patients instead of fixing errors. Clear workflows, checklists, and defined responsibilities for each team member save time, prevent mistakes, and make your practice run more smoothly.

Compliance and Audit Protection

Following coding requirements, keeping accurate records, and complying to payer rules protects your practice from audits or penalties. Proper documentation makes your every claim audit-ready, and regular staff training prevents mistakes in the first place.

Profitability

Using correct procedure codes, billing for all qualified services, and following your insurer’s requirements ensures that you’re paid fully against claim submissions. Slight improvements in coding and claims follow-up reduce lost revenue and increase income.

Now since we’ve discussed how precise dental billing and coding improves your practice’s finances, let’s deep dive into both these processes. And explore how billing and coding work and ways for you to convert claims into dollars.

What Is Dental Billing?

Dental billing involves managing finances between dental practices, patients, and insurers. Practices generate claims or invoices to recover payment for dental procedures on insured patients at a practice.

For that, you can either submit claims to insurance companies, or generate invoices to patients for out-of-pocket costs, which aren’t covered by the insurance plan.

To understand how it works and what are the best ways to ensure smooth claim recovery, let’s discuss this process step-by-step.

Payer Policy Rules

The accuracy of your entire dental billing relies on understanding payer policy rules. Each insurance company defines its own:

• Coverage policies
• Frequency limitations
• Age restrictions
• Required documents
• Prior authorization rules for certain dental procedures

Policies can vary significantly between payers, so staying current with changing policies is a must for clean claim submission and reimbursement.

You can do that by reviewing your insurance company’s updates regularly, so your billing staff and dental care providers know:

• Procedures covered in the insurance plans
• Treatments requiring pre-approval
• Documentation for each claim

Misinterpreting or overlooking insurer’s rules leads to delayed or reduced payments, or even straight claim denials.

Once you understand these guidelines, incorporate these into your billing processes, treatment planning, and patient communication. This leaves no room for confusion, while you also get accurate estimates for treatment costs.

Eventually, this leaves you and your patients satisfied as you know how to submit claims beforehand. As a result, both of your clinical and billing teams operate with clarity, consistency, and confidence when submitting claims.

Eligibility and Benefits Verification

Once you’ve understood payer rules, you can start your dental billing process with ease. The first major step is to verify a patient’s eligibility for a dental procedure and benefits they can receive. With this process, you know everything about the patient’s active coverage and financial responsibility before treatment begins.

Eligibility verification confirms if the patient’s dental insurance plan is active. 

The table below features an eligibility verification checklist explaining what you must confirm before submitting claims:

By following this checklist, you can easily verify benefits and limitations in advance, leading to clean claim submissions and a massive decrease in claim denial rate by insurers along with unexpected bills. It also helps your patients know what they’ll pay, so you can charge them on the spot, and receive your payments on time.

You can verify eligibility by checking the status through payer portals provided to you by insurance companies, or directly contacting insurers to know how much is covered in a patient’s insurance plan.

One more thing to note is that insurance verification isn’t just limited to dental procedures. It also helps check both dental and medical benefits for procedures that may cross categories, such as oral surgery, trauma care, or pathology. These are dental-related but medical in nature. Sometimes, these are entirely billed under medical claims, while on a few instances, CDT and CPT codes are used if both dental and medical procedures are performed.

Fee Schedule Management

Once insurance eligibility has been verified and an appointment has been scheduled, fee schedule management begins. It involves organizing, updating, and maintaining your contracted fees across all participating insurance plans. 

Each company offers its own reimbursement rates for CDT codes. You must carefully compare them against your practice’s standard fee schedule to ensure that you’re being compensated fairly for dental services rendered. Ignoring proper fee schedule management may lead you to experience significant financial loss with:

• Undercharging
• Estimating patient costs wrongly
• Accepting reduced payments

To avoid that, manage your fee schedule the right way by:

• Tracking annual updates from payers
• Renegotiating fee schedules when necessary
• Ensuring changes reflect in your practice management software

With accurate fee schedule management, you can precisely plan treatments, submit claims with clean rates, and bill patients correctly. You can also identify which procedures can generate profits for you, and emphasize on these treatments to maximize revenue growth opportunities.

Practice Management Workflow Integration

Practice management workflow integration ensures that all clinical, administrative, and billing processes operate with coordination. It focuses on aligning various billing-related tasks through one platform, such as an EHR system or a practice management tool. Together, in one system, it can manage tasks like:

• Appointment scheduling
• Treatment planning
• Dental coding
• Documentation
• Claim submission
• Payment posting

The purpose of integrating multiple workflows into a unified system is to make it easier for billing teams to access all the important information such as:

• Procedure details
• Prescriptions
• Radiographs
• Chart notes

It also allows your various teams like front desk staff, clinical teams, and billing staff to coordinate with each other. It helps you to assemble all the required documents in one place and submit claims smoothly.

Insurance Claim Management

Insurance claim management is the complete process of creating, submitting, tracking, and following up on insurance claims. Major steps in insurance claim management include:

• Gathering complete documentation
• Attaching required clinical notes and x-rays
• Coding procedures as per ADA’s guidelines
• Entering all the patient details correctly
• Submitting claims to the insurance company
• Tracking claims after submission to identify issues like delays or missing details
• Monitor claim status in payer portals
• Follow up on unpaid and pending claims

With proper insurance claim management throughout the process, you ensure that your claims are settled fast with maximum collections. 

The below checklist elaborates on what’s required in the claim submission steps. It’s crucial for clean claims and speedy payments:

Furthermore, following up on claims notifies the payer of their responsibility to settle pending dues.

This drives financial growth for your practice and also reduces administrative stress for your staff, freeing them up to perform their primary task of caring for the patients.

Claim Scrubbing & Error Prevention

Claim scrubbing is the process of reviewing claims before submission to detect errors and rectify them on time, preventing claim denials beforehand. Claims can be scrubbed either manually or using automated tools that verify all the details in your claim submission including: 

• CDT codes
• Documentation
• diagnosis codes
• patient information
• provider details
• attachments like X-rays and narratives

From spelling mistakes to incorrect coding and incomplete documentation, claim scrubbing helps identify everything. Plus, it also checks if your claim submissions adhere to insurer policies and even state policies, ensuring that you stay compliant. This reduces errors almost completely, making your claim submissions clean and accurate.

Dental Billing Compliance

Dental billing compliance ensures that all of your claims must follow legal, ethical, and payer-specific rules. Compliance includes:

• Accurate coding as per ADA standards
• Correct documentation
• Adherence to Health Insurance Portability and Accountability Act (HIPAA)
• Adherence to state and federal regulations

Moreover, to stay compliant, you must also avoid engaging in illegal activities like upcoding, unbundling, and billing for non-covered or unperformed services. Staying compliant protects your practice from audits, fines, and legal risks.

You must strengthen your practice’s compliance team, so it monitors your claim submissions, ensuring that you’re following all the legalities. For that, you need to:

• Train your staff
• Conduct frequent billing audits
• Maintain documentation standards
• Prepare a compliance manual

Denied Claims & Appeals
Claim denials are a frequent issue for dental practices, making claim management and appeals, a critical step in recovering revenue.

For claim denial management, you must:

• Review denial reasons
• Correct errors
• Attach missing documentation
• Resubmit claims within payer deadlines

Claim denial management is stressful for your staff, so they have to start the process all over again.

If your claims are reimbursed and still incomplete, file appeals with detailed explanations and supporting evidence to your insurer.

Here, you must identify major reasons for claim denials to prevent the issue. Claims are often denied due to errors like incorrect CDT codes, incomplete documentation, and eligibility verification issues. 

Efficient denial management improves cash flow and reduces write-offs. It also helps identify recurring issues in the practice’s billing workflow so that future denials can be prevented.

Below is a checklist that explains how you can appeal for rejected claims with success. Following it is very helpful for your claim resubmission.

Accounts Receivable (AR) Management

AR management involves tracking outstanding insurance and patient balances to ensure timely collection and healthy cash flow. It includes:

• Monitoring unpaid claims
• Following up with insurers
• Sending patient statements
• Prioritizing overdue accounts

Effective AR management helps reduce aging balances, minimize revenue losses, and improve your practice’s financial stability.

Patient Billing and Collections

While dental billing mostly focuses on recovering claims from insurers, an important aspect is patient billing.

This aspect focuses on collecting the patient’s portion of treatment costs that are not covered by the payer in the dental insurance plan. 

Some of the patient’s out-of-pocket expenses include deductibles, copays, coinsurance, or non-covered services, which you must charge the patient.

To make amount recovery smoother from patient billing, you must: 

• Create clear statements
• Offer payment plans
• Communicate costs upfront

Transparent patient billing not only helps you recover your amount timely, but also strengthens your trust with the patient. 

To make your patient billing effective, train your staff to communicate patient responsibilities confidently and compassionately. Billing patients before performing a procedure makes it easier to recover the amount, and it’s possible only with real-time patient insurance eligibility verification.

Now, as we’ve explored the steps in dental billing, let’s delve into a key part of your billing process: dental coding.

What Is Dental Coding?

Dental coding is of utmost importance in ensuring claim settlements. In this process, CDT codes are mentioned on a dental claim form. Insurance companies use these codes on claim submission forms to identify a dental procedure and evaluate your claims.

Using these codes, along with the right documentation, and sometimes ICD-10 codes for medical billing or dental-medical cross-coding, justify a dental procedure.

CDT Coding Fundamentals

CDT coding fundamentals standardize how dental procedures are reported to insurance companies. The Current Dental Terminology (CDT) code set includes procedure codes, nomenclature, and descriptors established by the ADA. Understanding these fundamentals ensures that your claims are submitted correctly against a dental procedure.

Each CDT code is categorized by service type, such as:

• Diagnostic
• Preventive
• Restorative
• Endodontic
• Periodontal
• Prosthodontic
• Oral surgery
• Cosmetic
• Adjunctive

Your coders must understand the purpose of each category to assign the correct code for each dental procedure.

Moreover, they must also have a strong grip on CDT coding essentials. Gaining in-depth information on it helps avoid denials. So, let’s have a breakdown of all these rules with examples in the table below:

CDT coding fundamentals also involve staying updated annually, as the ADA revises, adds, or deletes codes each year. Mastering these basics helps your practice stay compliant, reduce claim rejections, and communicate clearly with both insurers and patients about the dental services provided.

Dental Coding Mistakes

Dental coding mistakes frequently lead to denied claims, underpayments, and compliance issues that may make your practice prone to audits and unbearable revenue losses.

To avoid that, let’s identify some common coding errors with examples:

Most Common CDT Codes

Currently, there are 900+ CDT codes defined by ADA, which is a huge number to remember. However, the best part is that being a dental care provider, you don’t need to remember them all unless required. You can remember the most common CDT codes routinely performed in dentistry.

Understanding these codes ensures accurate billing and helps your practices streamline documentation and claims submission.

Knowing these common codes helps your coding team maintain efficient workflows, as the documentation requirements and rules are set by insurance companies for each procedure.

Coding Errors and Correction Methods

Coding errors may vary according to speciality, but generally major errors are the same. These include:

• Misclassification of dental procedures
• Use of outdated codes
• Submitting incomplete or incorrect documents
• Ignoring payer-specific rules
• Frequency violations
• Missing tooth or surface information
• Confusing similar procedure categories

You might feel that documentation and rules may not relate to coding, but your coding identifies everything you fill in the claim form and the documentation you attach with it. So, coding is related to that.

These mistakes can result in claim denials, delayed payments, or underpayments. 

Effective correction methods begin with thorough claim scrubbing, internal audits, and staff training.

Supporting documentation, such as clinical notes, radiographs, and treatment plans, must accompany corrections to strengthen your resubmission. Some payers require a specific appeal or resubmission format, so understanding each carrier’s procedures is essential. Preventative strategies include using updated CDT codes, verifying coverage before treatment, employing a robust coding software, and maintaining standardized documentation practices. 

Continuous education on coding guidelines, payer policies, and regulatory updates reduces recurring errors. Implementing these correction methods ensures claims accurately reflect services rendered, improves reimbursement efficiency, and maintains compliance with legal and ethical standards.

Documentation Requirements

Documentation requirements are critical for supporting dental procedures, verifying medical necessity, and ensuring compliance with insurance and regulatory standards. Complete documentation should include the:

• Patient’s medical and dental history
• Clinical examination findings
• Diagnostic imaging
• Chart notes
• Treatment plans
• Consent forms

Each procedure must be clearly linked to its corresponding CDT code, with complete detail to justify coverage, leaving no reason for claim denials. For instance, restorative procedures require tooth numbers, surfaces, and material specifications, while periodontal treatments require charting and pocket measurements. 

Proper documentation is essential for audits, claim approvals, and appeals, as incomplete records often lead to denials. Your EHRs and dental practice management software facilitate accurate documentation by standardizing fields, reducing human error, and providing audit trails. 

Documentation must also align with payer-specific requirements, including any additional forms or supporting evidence requested. Maintaining detailed and organized records protects your practice from compliance violations, ensuring accurate billing, and supports patient care continuity.

Medical-Dental Cross Coding

Medical-dental cross coding occurs when a procedure could be billed under either medical or dental insurance, depending on its purpose, diagnosis, and coverage rules. This often applies to oral surgery, trauma care, pathology-related procedures, or systemic conditions affecting oral health. 

For example, a jaw fracture repair may be billed to medical insurance, while a routine tooth extraction falls under dental coverage. Accurate cross coding requires verifying the patient’s medical benefits, documenting the clinical necessity, and choosing the correct CDT or CPT code. 

Errors occur when procedures are billed under the wrong plan, leading to denials, delayed reimbursement, or patient balance disputes. Proper cross coding involves collaboration between clinical and billing staff, careful review of payer rules, and clear documentation of the condition and treatment. 

Benefits verification is essential to determine which insurer is primary and how coordination of benefits affects payment. Cross coding also requires tracking patient responsibility when medical insurance covers part of a dental procedure. Accurate application ensures compliance, timely reimbursement, and reduces administrative burdens while maintaining transparency with patients regarding coverage.

Payer-Specific Coding Requirements

Payer-specific coding requirements refer to the unique rules each insurance carrier establishes for claim submission, reimbursement, and documentation. Although ADA’s CDT codes provide standard nomenclature, carriers may impose additional stipulations, such as age restrictions, frequency limitations, prior authorization, or material downgrades. 

Some insurers require narrative justification, radiographs, or periodontal charts for certain procedures, while others may restrict coverage to medically necessary interventions. 

Coding errors often occur when practices solely follow CDT rules without consulting the specific payer guidelines. For example, a crown code may be covered differently by Medicaid versus a commercial PPO, including different replacement intervals or material limitations. 

Staff must review payer manuals and updates regularly and incorporate these rules into internal workflows and claim submission protocols. Using payer-specific templates, automated alerts, and verification tools can reduce errors. 

Accurate adherence ensures timely reimbursement, fewer denials, and compliance with contracts. It also helps in estimating patient out-of-pocket responsibility and communicating coverage expectations. Awareness of these requirements is critical for maintaining financial efficiency, reducing administrative rework, and supporting ethical, compliant billing practices.

CDT Code Updates

CDT code updates are issued annually by the American Dental Association to reflect changes in dental practice, technology, and regulatory requirements. Updates include new codes, revised descriptors, and deleted codes. Staying current with these changes is essential for accurate claim submissions, proper reimbursements, and compliance with regulations. 

You need to integrate the updated CDT codes into your management systems, fee schedules, and internal coding guidelines each year. New codes often address emerging procedures, materials, or technologies, while revisions clarify descriptors, add limitations, or improve coding accuracy. Deleted codes must be replaced with appropriate alternatives to prevent claim rejection. 

Staff training is essential when codes change, ensuring that your billing staff understands new or modified procedures, documentation requirements, and payer implications. Automated systems and software updates help practices implement changes efficiently, but human oversight is still required to ensure clinical documentation aligns with updated codes. 

Failure to adopt CDT updates can result in claim denials, incorrect reimbursement, or audit risk. Regular review of ADA releases, payer notifications, and internal audits ensures that coding remains accurate, compliant, and aligned with current standards.

Now, before we dive into these specialties, we’ll discuss some common coding types that cover various specialties.

General Dentistry Coding

General dentistry coding includes routine procedures not specific to one dental specialty. These include:

• Examinations
• Prophylaxis
• Radiographs
• Minor restorations
• Basic adjunctive services

Some common examples of procedures across various categories coded into general dentistry coding include:

Pediatric Dentistry Coding

Pediatric dentistry coding addresses procedures performed specifically for children, including preventive and restorative services. Common codes include:

Additional codes cover sedation, space maintainers, stainless-steel crowns, pulpotomies (D3220), and early orthodontic interventions.

Pediatric coding often requires careful attention to age-based coverage rules, payer restrictions, and medical necessity documentation for certain procedures. Wrongly categorizing procedures, such as using adult prophylaxis codes for pediatric treatment, or incorrect coding of preventive services, frequently leads to denials.

Documentation must include age, tooth numbers, surfaces treated, behavior management notes, and any clinical justification for advanced procedures. Verification of benefits is essential, as some pediatric services may be covered under medical plans, Medicaid, or specialized dental programs.

Accurate pediatric coding is critical to protecting revenue for your dental practice while providing high-quality care for young patients, as they require special care and attention, as compared to adults.

Sedation Dentistry Coding

Sedation dentistry coding includes procedures that involve pharmacological management to reduce patient anxiety or facilitate treatment. Common CDT codes include:

• D9222 (deep sedation/general anesthesia, first 15 minutes)
• D9223 (each additional 15 minutes)
• D9248 (non-intravenous conscious sedation)

Accurate sedation dentistry coding requires:

• Documentation of patient consent
• Medical history
• Vital signs
• Medications used
• The duration and level of sedation administered

Many payers require prior authorization, especially for pediatric patients, patients with special needs, or medically compromised adults.

Errors in coding and claim submissions commonly occur when:

• Sedation is billed without proper clinical justification
• Time duration is incorrectly calculated
• Difference between intravenous and non-intravenous sedation isn’t properly applied

Sedation coding often intersects with other procedure codes, such as restorations or extractions, so documentation must clearly separate the sedation service from the primary procedure. Insurance coverage varies widely, with some plans limiting payment to medically necessary cases or entirely excluding elective sedation by patients.

Now, we’ll proceed to the coding specialties

Diagnostic Coding

Diagnostic coding covers procedures used to assess a patient’s oral health, identify conditions, and determine treatment needs. This category includes:

• Comprehensive exams (D0150)
• Periodic exams (D0120)
• Limited problem-focused exams (D0140)
• Radiographic services:
• Bitewings (D0272–D0274)
• Panoramic images (D0330)
• Periapical imaging (D0220–D0230)

Accurate diagnostic coding is critical because many insurers limit these services by frequency, age, or coverage tier. Proper documentation must support the chosen code, such as recording why a limited exam was required or providing clinical justification for additional radiographs. 

Diagnostic coding also includes adjunct procedures such as:

• Pulp vitality tests (D0460)
• Adjunctive test for oral cancer screenings (D0431)
• Caries risk assessments (D0601, D0602, D0603)

Claims are denied due to diagnostic coding errors resulting from confusing exam types or using an exam code when the service performed doesn’t match the descriptor. 

Moreover, if an insurance plan permits examinations only once every six months, and if a diagnosis is performed, the claim may be denied. You can prevent that by verifying a patient’s eligibility ahead of time, checking the frequency limitations for exams in a patient’s insurance plan.

Preventive Coding

Preventive coding includes services intended to maintain oral health, prevent disease progression, and reduce future treatment needs. Common preventive CDT codes include:

• D1110 (adult prophylaxis)
• D1120 (child prophylaxis)
• D1206-D1208 (topical fluoride applications)
• D1351 (sealants)

Preventive services represent a major portion of routine dental care, and correct coding is essential due to strict payer rules, especially regarding frequency limitations and age-based criteria. 

Documenting clinical indications, such as plaque buildup, patient age, caries risk, or tooth surfaces eligible for sealants, helps support preventive claims. Some preventive services require specific documentation, such as fluoride varnish application details or tooth numbers for sealants. 

Misunderstanding the difference between preventive and periodontal classifications is one of the most common coding issues. For example, prophylaxis is preventive, while scaling and root planing falls under periodontal services. Confusing the two can lead to incorrect coding and eventual denials. 

Preventive coding may also differ between dental and medical plans, especially for services that overlap both of these. Examples include fluoride treatment for high-risk children or oral hygiene instruction covered by medical plans.

Restorative Coding

Restorative coding covers procedures that restore tooth structure lost to decay, fractures, or wear. 

Common CDT codes include amalgam restorations (D2140–D2161) and composite restorations (D2330–D2394), which vary by the number of surfaces treated. Proper documentation must specify tooth numbers, surfaces, materials used, and the clinical reason for the restoration. 

Crowns form another major part of restorative coding, with codes such as:

• D2740 (ceramic crown)
• D2750 (porcelain-fused-to-metal crown)
• D2790 (full metal crown)

Insurers often apply downgrades or strict criteria for crown coverage, making accurate coding essential.

Additional restorative services include:

• Core buildups (D2950)
• Prefabricated crowns (D2930–D2934)
• Onlays/inlays (D2542–D2664)

Coverage rules for restorations often vary by documented decay, fracture lines, or previous restorations. Errors occur when:

• Restorations are coded without surface accuracy, meaning how accurately a tooth is identified, charted, and billed on a dental claim
• Radiographs don’t support treatment
• Buildup codes are used without meeting medical necessity requirements

Understanding payer policies on replacement intervals, material downgrades, and frequency limits is crucial for successful reimbursement on restorative claims. Restorative coding also requires you to know when a service falls under prosthodontic coding, such as larger indirect restorations.

Periodontal Coding

Periodontal coding covers procedures used to diagnose, treat, and manage diseases affecting the gums and supporting structures. Common CDT codes include:

• D4341 and D4342 for scaling and root planing
• D4910 for periodontal maintenance
• D4381 for localized delivery of antimicrobial agents

Accurate documentation is essential because insurers often require:

• Periodontal charting
• Radiographic evidence of bone loss
• Detailed narratives supporting diagnosis

Coding errors frequently occur when prophylaxis (D1110) is mistakenly used instead of scaling and root planning, or when periodontal maintenance is incorrectly billed as a routine cleaning. Understanding the differences between these services ensures compliance with payer rules and appropriate reimbursement. 

Periodontal coding also includes more advanced procedures such as: 

• Osseous surgery (D4260, D4261)
• Soft tissue grafts (D4277, D4278)
• Crown lengthening (D4249)

These codes typically require extensive justification and preauthorization, depending on the payer policy. Replacement intervals, site-specific requirements, and quadrants must be accurately described in the claim form.

The reason is that periodontal treatment often involves multiple appointments and treatments. Therefore, you must properly submit claims for each procedure in the same order that it’s performed.

Oral Surgery Coding

Oral surgery coding encompasses procedures that involve the extraction, removal, or surgical alteration of oral structures. Common CDT codes include:

• D7140 (simple extraction)
• D7210 (surgical extraction)
• D7230–D7250 for impacted tooth extractions
• D7510–D7511 for incision and drainage of abscesses

Coding accuracy depends on documenting the complexity of the procedure, including bone removal, sectioning, flap elevation, or infection management. 

Payers examine surgical claims very closely and carefully, so it’s essential to maintain a record of radiographs and clear clinical notes, and attach them with your claim forms to fulfill documentation requirements. 

Oral surgery coding also includes:

• Biopsies (D7285, D7286)
• Frenectomies (D7961, D7962)
• Surgical exposure of teeth for orthodontic purposes (D7280)

Insurers may classify certain surgeries as medical benefits when trauma, pathology, or systemic involvement is present. Misclassifying these procedures as dental can lead to avoidable denials. This leads us to the common coding challenges that arise when dental coders can’t distinguish between simple and surgical extractions, or document the need for surgical intervention.

Prosthodontic Coding

Prosthodontic coding applies to procedures that restore or replace missing teeth using fixed or removable prostheses. 

Common fixed prosthodontic codes include bridges (D6240–D6750), and abutment preparations.

Removable prosthodontic codes cover:

• Complete dentures (D5110–D5120)
• Partial dentures (D5211–D5214)
• Adjustments or repairs (D5410–D5712)

Accurate prosthodontic coding requires documentation that supports medical necessity, such as missing teeth, structural failure, fracture, or recurrent decay. Payers often require you to justify prosthodontic procedures by submitting the proof that teeth can’t be restored with standard procedures when planning bridges or other prosthodontic replacements. So, it’s important that you code prosthodontic procedures very carefully, while fulfilling documentation requirements.

Keeping that in mind, you must also know some frequent challenges in prosthodontic coding. One major issue is distinguishing between restorative indirect services (inlays, onlays) and prosthodontic crowns. Another challenge is ensuring the correct coding of denture relines or rebases, depending on the extent of the procedure. Many insurance plans apply downgrades to material types or limit coverage to basic prosthetics.

Your prosthodontic claims can be successfully reimbursed with proper impressions, radiographs, narratives, and documentation of occlusion or bite changes.

Orthodontic Coding

Orthodontic coding encompasses procedures that correct malocclusion, misaligned teeth, or jaw discrepancies, typically for both functional and aesthetic reasons. Common CDT codes include D8010–D8090 for comprehensive treatment, including full records, active therapy, and periodic evaluations. 

Interceptive treatment codes (D8010, D8020) apply to early-stage correction in children, while retention procedures (D8680, D8693) cover post-treatment appliances. Accurate coding requires documentation of diagnosis, malocclusion severity, treatment plan, and appliance type. 

Many insurers limit coverage by patient age, medical necessity, or prior authorization requirements. Errors often arise when routine dental procedures are mistakenly billed as orthodontic services or when incomplete records fail to support treatment codes. 

Submitting clear clinical notes, photographs, and diagnostic records is essential to improve chances of your orthodontic claims being approved. Understanding payer-specific rules, such as coverage for adults and children, or medical-dental crossovers for craniofacial anomalies, is critical, so you code each procedure accurately for reimbursements.

Cosmetic Coding

Cosmetic coding includes procedures primarily performed to improve the appearance of teeth, gums, or smiles rather than to address functional or medical needs. Common procedures include:

• Bleaching/whitening (D9972, D9971)
• Veneers (D2962, D2963)
• Enameloplasty or contouring (D2960, D2970) 

Cosmetic procedures often have limited or no coverage under standard dental insurance, requiring accurate coding for proper patient billing and transparency. Documentation must clearly indicate whether the service is cosmetic or medically necessary, especially when the same procedure serves both purposes. 

For example, a veneer placed to repair a fractured tooth may be partly restorative and eligible for reimbursement, while purely aesthetic applications typically are patient-responsible. 

Billing errors often occur when cosmetic procedures are incorrectly coded as preventive, restorative, or covered services, leading to claim denials. Remembering common codes and checking these codes from ADA’s lists beforehand ensures that you properly code cosmetic dental procedures.

Dentures and Implants Coding

Dentures and implants coding covers removable and fixed prosthetic solutions for missing teeth. Common codes include:

• Complete dentures (D5110, D5120)
• Partial dentures (D5211–D5214)
• Implant placement (D6010, D6011)
• Abutments (D6056)
• Implant-supported prostheses (D6058–D6066)

Accurate coding requires documentation of:

• Areas with no teeth
• Bone quality
• Prior treatments
• Patient-specific prosthetic needs

Many insurance plans impose strict coverage rules, replacement intervals, and prior authorization for these services. Common errors include:

• Coding implant procedures without medical necessity documentation
• Misinterpreting the difference between removable and fixed prosthetics
• Omitting abutment and restoration codes

Along with the right documentation, dentures and implant coding also requires understanding downgrades applied by payers, such as limiting reimbursement to standard materials or basic prostheses.

Endodontic Coding

Endodontic coding covers procedures related to diagnosis and treatment of dental pulp and periapical tissues, primarily root canal therapy. Common CDT codes include:

• D3310–D3330 for anterior, premolar, and molar root canals
• D3346–D3348 for retreatment
• D3351–D3353 for apicoectomy procedures 

Accurate coding requires documentation of:

• Tooth number
• Canals treated
• Diagnostic findings (pulp vitality, infection, or necrosis)
• Proper reasoning for treatment to justify its categorization and claim filing

Errors commonly occur when the wrong tooth type or canal number is coded, or when retreatment is billed without documentation of previous therapy. Adjunctive procedures such as post placement (D2950) must be coded separately if performed.

Common Terms in Dental Billing Explained for Quick Reference

A practical glossary of dental billing gives your teams a know-how of the terms used in billing processes, claim submissions, and reimbursements, when working with insurance companies. While the list is huge, we’ll list down some common terms every dental biller, treatment coordinator, and front office team member should know.

A shared glossary empowers your billing staff to communicate clearly, reduce rework, and submit cleaner claims on the first attempt.

Common Letters in Dental Billing and Coding

Certain steps in your dental billing and coding process require writing letters to payers or patients. Let’s discuss professional ways to write these letters, which increases your chances of recovering payments for dental services rendered.

Appeal Letter

A well-structured appeal letter increases the chances of overturning a denial. When writing one, focus on clarity, accuracy, and supporting evidence:

• Start with essential claim identifiers: Include patient name, date of service, subscriber ID, treating provider, and claim number so the payer can immediately locate the case.
• State the purpose clearly: Begin with a direct statement that you are appealing a denied or reduced claim and identify the denial reason from the EOB/ERA.
• Explain medical/dental necessity: Provide a concise clinical rationale based on symptoms, diagnosis, radiographic findings, narrative details, and treatment justification.
• Reference payer policies: Cite specific sections of the insurance carrier’s clinical guidelines, coverage rules, or contract language that support your request.
• Summarize supporting documentation: List attachments such as X-rays, perio charting, progress notes, and previous correspondence.
• Maintain a professional tone: Keep the content factual, respectful, and focused on resolving the denial.
• End with a clear request: Ask for reprocessing or reconsideration of the claim based on the evidence provided and sign the letter with the treating provider’s name and credentials.

Below is a template for writing a professional letter, appealing for reprocessing of denied claims:

Predetermination Request Letter

Predeterminations are essential for costly or complex treatment procedures, such as:

• Crowns (porcelain or metal-ceramic) due to material and coverage limits
• Orthodontic treatment (braces or aligners) to verify medical necessity and age or frequency restrictions

These prevent unexpected out-of-pocket charges and reduce the risk of non-payment after service. A polished template helps your team submit requests quickly and consistently.

Now, to write one:

• Include patient and plan information: Clearly state patient name, date of birth, subscriber ID, and the insurance plan to ensure the request is matched correctly.
• Identify the proposed treatment: List each dental procedure with corresponding CDT codes, planned tooth numbers, surfaces, and any materials involved.
• Provide clinical justification: Explain why each procedure is necessary, including symptoms, diagnosis, radiographic evidence, periodontal charts, and any relevant medical history.
• Reference coverage guidelines: Cite insurer rules, policy manuals, or evidence-based recommendations that support the planned treatment’s necessity.
• Summarize attachments: Mention supporting documentation such as X-rays, intraoral photos, treatment plans, and prior notes.
• Request explicit confirmation: Ask the payer to confirm coverage, estimate patient responsibility, and indicate any preauthorization or frequency limitations.
• Maintain professional tone: Keep the letter concise, clear, and respectful, signed by the treating provider with credentials.

This approach ensures the insurance company has all the necessary information to approve or clarify coverage before treatment, reducing the risk of denials or delays.

This template explains how you can write a predetermination request for certain dental procedures.

Predetermination Request Template

Patient Billing Communication Letter

A patient billing letter is needed to inform patients of their financial responsibility for dental services, clarify insurance coverage, and provide payment instructions. It is typically sent after claim processing when a patient needs to pay a portion of the treatment cost.

The letter should clearly communicate balances, payment options, and insurance responsibilities in a professional and empathetic tone. Key components include:

• Patient and account details: Include patient name, date of service, invoice number, and total amount due for easy reference.
• Breakdown of charges: Specify each procedure, cost, insurance-covered portion, and patient responsibility (deductibles, copays, coinsurance, or non-covered services).
• Payment instructions: Clearly outline accepted payment methods (online, check, card, payment plans) and deadlines.
• Insurance explanation: Briefly explain how insurance processed the claim and why the patient must pay a certain amount. Avoid technical jargon, making it easy to understand for the patient.
• Contact information: Provide phone/email for billing inquiries or clarification. Encourage patients to reach out if they have questions.
• Professional and empathetic tone: Maintain clarity and respect to build trust, while emphasizing the importance of timely payment.
• Optional reminders: Include reminders for upcoming appointments or pre-payment for planned procedures.

A well-crafted letter leads to no confusion between your patients and staff, while speeding up collections, and strengthening patient trust.

Patient Billing Communication Template

Reading Explanations of Benefits

An explanation of benefits (EOB) is a statement from an insurance company that explains how a dental or medical claim was processed. It details the billed amount, allowed amount, adjustments, payments made, and any patient responsibility, helping you and your patient understand coverage and reimbursements.

It’s essential for posting payments and correctly identifying underpayments and denial reasons. A well-trained billing team can quickly spot inaccuracies that can drain your practice’s revenue.

To assist you with that, we’ll guide you through what it contains and how you can identify errors and rectify them to maintain your practice’s financial stability. So, let’s discuss that in detail.

Key Components of EOB

Billed Charge

Billed charge is the amount submitted by a dental provider for a procedure. It’s based either on a practice’s standard fee schedule or the usual, customary, and reasonable (UCR) rate, which is the standard amount set by an insurance company for a procedure within an area.

A billed charge represents what you should expect to receive before any contractual agreements or insurance adjustments. Understanding these charges helps you identify differences between your expected reimbursement and actual amount settled by the insurance company.

Allowed Amount

It’s the maximum amount an insurance company pays for a procedure. This is usually determined by your contract with an insurance company, and may be lower than the billed charge. Knowing the allowed amount helps your practice anticipate coverage, calculate patient responsibility, and identify any discrepancies between expected and actual reimbursement.

Adjustments

Adjustments are reductions applied to the billed charge. They can occur due to contractual agreements, plan frequency limits, procedure exclusions, downgrades or coordination of benefits. Reviewing adjustments ensures claims are processed accurately and highlights potential areas for appeal or correction.

Paid Amount

It’s the actual amount settled by the insurance company against a claim. This is based on the allowed amount, excluding any adjustments. Tracking the paid amount helps ensure that you’re receiving proper reimbursement and allows for follow-up on underpaid or delayed claims.

Patient Responsibility

As we’ve discussed, the patient’s responsibility includes any portion of the bill the patient must pay, such as deductibles, coinsurance, copays, or charges for non-covered services. Clear communication with the patient about their responsibility ensures timely payment and avoids confusion or disputes.

Denial Codes

Denial codes are numeric or alphanumeric indicators that explain why an entire claim or some of its portion is denied by the insurer. Understanding these codes allows your billing teams to take corrective actions, submit appeals, or request additional documentation to recover reimbursement.

The table below describes some common denial codes:

Denial Code	Meaning / Explanation	Suggested Action
CO-45	Charge exceeds fee schedule or maximum allowable.	Check if the procedure exceeds the patient’s plan limits or contracted fee; consider submitting an appeal or patient balance.
CR-50	Duplicate claim/service.	Verify if the service was already processed; if not, submit a corrected claim.
CO-119	Benefit not covered.	Review plan policy for exclusions; inform patient if out-of-pocket applies.
CO-97	Preauthorization/Predetermination required but not obtained.	Obtain prior authorization and resubmit claim.
CO-197	Patient ineligible or coverage terminated.	Confirm patient’s insurance eligibility, update patient info and resubmit if applicable.

However, EOBs may not always be correct. They often require review, so you must evaluate EOBs and see if there are any errors.

Identifying Errors in EOBs

Compare Allowed Amounts

Compare the maximum allowed amount to your contracted rate to ensure the payer is reimbursing correctly. Discrepancies may indicate underpayment or billing errors. 

And if you find that the allowed amount is lower than your contract, contact the payer to correct underpayment.

Review Adjustment Codes

Check adjustment codes for accuracy. Confirm these codes reflect the plan rules, exclusions, downgrades, and coordination of benefits. Incorrect codes can lead to denied or underpaid claims. If you identify inaccurate coding, submit a corrected claim and properly explain coding for rectification.

Confirm Downgrade Accuracy

If a procedure has been downgraded, verify that it’s according to your contract rules. Proper documentation helps justify your billed service if you submit the appeal.

Check Claim Settlements Against CDT Codes

Ensure that your claim reimbursements complement the billed CDT codes. If these don’t match the coding, payments can result in underpayment or posting errors in the practice management system. If paid amounts don’t match the billed codes, request a payment correction from the insurer.

Document Discrepancies

Keep detailed records of any discrepancies for follow-up, whether through appeals or corrected claims. Documentation strengthens your appeals or resubmissions, and protects your practice from audits or legal complications, while also speeding up recovery of lost revenue.

Negotiating Fee Schedules

Negotiating fee schedules beforehand can help your practice maximize profits from claim settlements. Even slight increases improve long-term revenue across hygiene, restorative, periodontal, and major services.

Let’s explore step-by-step how you can negotiate fee schedules with the insurance companies, ensuring your compensation is fair for services rendered.

Step 1: Analyze Current Performance

Begin by reviewing your practice’s most frequently performed procedures, typically the top 25-50 codes by volume and revenue. Identify codes with consistently low reimbursement or high write-offs, as these significantly impact your profitability. 

In this step, you must also find payer’s reimbursement patterns, denials, or downgrades, so you can make data-driven requests for fee negotiations. The goal is to focus on areas where even small increases can meaningfully boost your overall revenue.

Step 2: Gather Supporting Data

Prepare objective evidence to support your request. Include regional cost-of-living adjustments, rising staffing or supply costs, and benchmark comparisons from national fee surveys.

Document high patient demand for your specialty services, which demonstrates the value of maintaining access at your current practice. Describing your practice’s operating costs and service utilization justifies your fee negotiation. Your reasoning should be compelling and fact-based to convince the payers to offer you reasonable pricing.

Step 3: Present a Justified Request

Submit a concise proposal to the payer with clear fee adjustments. Focus on procedures that are costly and are performed frequently, such as a periodic exam, adult prophylaxis, crown, or periodontal scaling. 

Highlight the clinical and operational costs against each procedure to justify your request for an increase. Submitting a well-structured proposal improves chances of your request to be reviewed seriously and considered for approval.

Step 4: Leverage Contract Expiration

Approach the insurance company just as your current contract is about to expire, as payers are more motivated to retain contracted practices. Initiating discussions early gives you leverage, especially if your practice represents a significant portion of patient access in the region. This is the best time to bargain and negotiate for rates. 

Early negotiations allow enough time for payer review, counteroffers, and mutual agreement, so contract renewal terms are settled on time.

Step 5: Evaluate Renewal Terms

Review all contract clauses carefully, including PPO leasing arrangements, silent PPO participation, and tiered reimbursement schedules. 

Make sure that any agreed-upon fee increases are applied uniformly across all relevant insurance networks. Watch for contract terms that could lower your actual payment, such as automatic reductions or bundled allowances. Carefully reviewing these details helps ensure your renewed agreement boosts revenue without any hidden restrictions that could reduce your earnings.

Common Challenges in Dental Billing and Coding

Let’s navigate the common challenges practices usually experience during dental billing and coding, impacting their claim submissions and overall revenue.

High Denial Rates Delaying Revenue

Claim denials disrupt revenue flow and often result from missing documentation, eligibility errors, or incorrect coding. Rules of insurance carriers can change unexpectedly, causing further denials. Identifying recurring denial patterns helps staff address root causes, correct errors before submission, and implement strategies that reduce rejected claims and improve cash flow.

Slow Payments and Rising A/R

Delayed insurance payments often increase your accounts receivable (A/R). Causes include incomplete claim submissions, missing attachments, and limited follow-up. Implementing automated reminders, tracking aging claims, and consistently reviewing denials ensures faster reimbursements, lowers write-offs, and helps maintain steady practice revenue while reducing financial stress.

Staff Turnover and Training Gaps

Frequent staff changes and insufficient training disrupt billing workflows. New employees may not have the updated documentation and follow outdated practices, causing repeated errors and delayed claims. Standardizing processes, maintaining reference guides, and investing in ongoing training ensures continuity, reduces mistakes, and strengthens overall practice efficiency.

Inconsistent Documentation

The charting quality, detail, and coding justification varies per each clinician. Incomplete notes often fail to support procedures like crowns, periodontal therapy, or oral surgery. Establishing clear documentation standards, templates, and periodic audits ensures that clinical records consistently justify treatment, reducing claim denials and supporting compliance and appeals.

Confusing Payer Rules

Each insurance payer has unique requirements for attachments, code usage, and procedure frequency. Misinterpretation leads to preventable claim denials and delays. Maintaining up-to-date payer guidelines, using checklists for submission, and educating staff on specific rules ensures claims are accurate and complete, minimizing disruptions to revenue flow.

Time Lost to Follow-ups and Appeals

Repeated calls, emails, and resubmissions consume staff time and delay other essential tasks. Efficient follow-up systems, organized documentation, and prioritized appeal workflows reduce administrative burden. Streamlining these processes improves reimbursement speed, lowers A/R aging, and allows staff to focus on patient care rather than administrative backlog.

Revenue Strain from Missed Codes

Missed or overlooked codes, such as D9910 (application of desensitizing medicament), D9930 (treatment of temporomandibular joint (TMJ) disorders, by report), D1208 (topical application of fluoride, excluding varnish), or adjunctive procedures, result in lost revenue. 

Regular coding audits, training, and checklists ensure all dental services are properly captured in your practice management system. Proactive review maximizes reimbursement, prevents revenue loss, and ensures accurate reporting for insurance and internal practice analytics.

Stress and Burnout Among Office Staff

Constant pressure to reduce A/R, verify eligibility, submit claims accurately, and follow complex and varying rules per payer can be exhausting for your staff, and lead to mistakes. 

To prevent that and boost staff productivity, you must provide support to your staff and smooth your workflows by automating billing processes and setting up realistic expectations and targets that can be easily achieved.

Identifying these obstacles is the first step toward finding an appropriate solution to improve your billing process.

Best Practices for Effective Dental Billing and Coding

Your claim reimbursements can be successful and profitable for your dental practice by following these practices. These not only lead to revenue growth but also ensure patient satisfaction, staff productivity, and better patient care. Let’s explore these solutions.

Improve Documentation to Reduce Denials

Accurate and detailed clinical documentation is crucial to prevent claim denials. Notes should clearly describe the reasoning for diagnosis, procedures, findings, and treatment. Supporting attachments like X-rays and charts strengthen your claim submissions.

Time-Saving Eligibility Verification Strategies

Confirming coverage and prior authorization upfront saves time and prevents denied claims. This is possible if you automate patient insurance eligibility verification, and prefer doing so in real-time with smart systems. 

Moreover, integrating with payer tools helps your staff quickly assess benefits, deductibles, waiting periods, and network status. Doing so timely clarifies patient responsibility, streamlines scheduling, and ensures that services rendered are reimbursable.

Coding Accuracy Systems for Consistency

Consistent coding is key to maximizing reimbursement and minimizing denials. Using coding reference guides, internal cheat sheets, and double-check processes ensures correct CDT alignment for every procedure. 

Proper coding reduces errors across staff, strengthens claims for audit and appeal purposes, and protects revenue while maintaining compliance with payer rules.

Financial Metrics and Reports

Tracking financial metrics and generating reports helps your practice evaluate billing performance and identify areas for improvement. Define some key metrics, so you know where you stand at the moment and what steps can be taken to make billing recovery smooth.

Some of these metrics include:

• Collections ratio
• Days in AR
• Claim denial rate
• First-pass acceptance rate

Regular reporting provides insight into your practice’s financial health and empowers you to make data-driven decisions for billing accuracy. Doing so helps maximize your collections and make your practice’s finances smoother.

Use Checklists to Streamline Repetitive Tasks

Checklists help standardize recurring billing tasks like eligibility verification, claim submission, predetermination, and appeals. We’ve already discussed checklists for all these processes to assist you with checking essentials.

Automate Billing Processes

Automation improves speed and accuracy in dental billing. Leveraging robust and high-end solutions like robotic process automation help streamline your entire revenue cycle management from eligibility verification and appointment scheduling to claim submissions, follow-up, and appeal management. These tools work efficiently, completing time-consuming tasks in just a matter of seconds with near accuracy. Manual supervision can make these processes more efficient with achievable outcomes.

Outsource Dental Billing

Outsourcing dental billing to a reliable partner like TransDental, can be a strategic solution for your practice to tackle issues like:

• High A/R
• Increasing manual errors leading to claim denials
• Staffing shortages
• Complex and varying payer rules

Billing teams leverage their expertise of working with multiple insurance companies and practices, and staying current with latest industry trends and updated codes. They can efficiently handle your claims, coding, and appeals.

Outsourcing increases revenue, reduces denials, supports rapid practice growth, and allows your in-house staff to focus on patient care and help restore their smiles.

Conclusion

Dental billing and coding is an essential part of a dental practice’s revenue cycle management, helping it run smoothly. Following each step in the entire process with all the ins and outs of billing and coding helps you submit claims precisely, ensuring a profitable revenue growth for your practice.

Frequently Asked Questions (FAQs)