Our team of expert billers and coders at TransDental provide specialized pediatric dentistry billing services designed to maximize your practice’s revenue while you focus on providing expert dental care to children.
Pediatric dental billing requires expertise in age specific procedure coding due to the unique nature of primary dentition treatment, behavior management services, and preventive care protocols that differ significantly from adult dentistry. TransDental’s pediatric dental billing specialists understand age-appropriate procedure coding, Medicaid/Denti-Cal requirements for pediatric patients, documentation standards for early childhood management, and current payer policies to maximize reimbursement and prevent revenue loss for pediatric dental practices.
Our Track Record Speaks for Itself:
40% Reduction in Account Receivables Over 90 Days
Same-Day Patient Account Resolution and Follow-Up
200K+ Successfully Processed Dental Claims Monthly
50+ Dental Insurance Payers in Our Network Database
HIPAA-Compliant Secure Data Management and Reporting
Our full service pediatric dental billing services manage every aspect of your revenue cycle, from patient registration to final payment posting. We don’t just process claims; we optimize your entire billing operation to maximize reimbursements and accelerate cash flow.
Many pediatric dental patients receive coverage through Medicaid, CHIP, or state sponsored programs. We navigate these complex programs and ensure timely reimbursement by fully complying with program regulations.
We verify insurance coverage prior to commencement of treatment focusing on pediatric dental benefits and determine coverage for preventive services, restorative procedures, behavior management, sedation, and emergency care.
For patients that have coverage through both parents' insurance plans, proper coordination of benefits is essential to maximize reimbursement. We submit the primary plan first and coordinate secondary claims to maximize benefits.
Pediatric dentistry procedures require specialized coding knowledge. Our team of certified coders accurately code pediatric procedures including pulpotomies, pulpectomies, stainless steel crowns, behavior management, and sedation services.
Children often require application of behavior management or sedation services and billing for these services requires proper medical necessity documentation and appropriate coding. Our team ensures that these services are billed correctly.
Insurance carriers often require pre-authorization before approving pediatric dental treatment, particularly for treatment under sedation or general anesthesia. We manage this process by submitting treatment plans with requisite documentation.
Pediatric dental treatments for special needs children are subject to additional billing complexities. Our team ensures proper billing for additional time and services with the requisite documentation supporting medical necessity of treatment.
Insurance policies vary regarding preventive care frequency for pediatric patients. Our team tracks these variations and ensures that preventive care is billed appropriately according to each patient's specific policy provisions.
Pediatric dentists in hospitals or surgical centers face unique billing challenges. We manage facility coordination and professional fee billing for hospital based procedures, ensuring adequate revenue capture for surgical center cases.
Pediatric dental claims are electronically submitted within 24 to 48 hours of receiving clinical documentation. For Medicaid and state program claims, we follow submission requirements and timelines mandated by each program.
Pediatric dental claims may be subject to denial for multiple reasons including frequency limitations, age restrictions or medical necessity disputes. Our denial management team investigates every rejection and files compelling appeals.
Pediatric dental treatments often require payments beyond insurance coverage. Our team provides clear explanations of insurance benefits and patient responsibilities. For families requiring assistance, we help establish payment plans.
TransDental understands your practice's performance across different demographics and guides strategic decision making. We provide monthly reports showing production and collections by payer category including self pay.
TransDental offers revenue cycle management services designed for every dental specialty. We help you uncover hidden revenue opportunities, improve billing accuracy, and enhance your practice’s financial performance.
Many pediatric dental practices believe handling billing in-house saves money. However, the true costs often remain hidden:
Including benefits, training, turnover, and lost productivity, an pediatric dental biller costs $45,000–$60,000 annually.
Billing software, clearinghouses, EDI connections, and regular updates require significant ongoing investment.
Coding changes, insurance policy updates, and regulatory requirements demand continuous staff education.
Every hour your team spends on billing is time not spent on patient care, practice growth, or revenue-generating activities.
Coding errors, missed charges, incomplete documentation, and lack of follow-up can cost practices 20-30% of potential revenue.
The average dental practice has a denial rate of 15-20%. Each denied claim requires 30-60 minutes to research, correct, and resubmit.
HIPAA violations, audit exposure, and documentation errors can lead to costly fines and delayed payments. Constant oversight is essential to stay compliant.
Increased paperwork, coordination and follow-ups, strain your front office, increase your costs, reducing efficiency and patient focus.
We believe in transparent pricing and delivering exceptional value. Our pediatric dental billing and coding services are priced as a percentage of collections, which means:
When you outsource RCM Services To TransDental, we function as an extension of your dental practice , supporting your staff and ensuring that your revenue stream keeps increasing and flowing seamlessly.
Pediatric dental practices face distinct complexities that set them apart from general dental practices. Our team of pediatric dentistry billing specialists are fully experienced and equipped to address all of these challenges. Some of these challenges are:
Time spent dealing with billing complexities is time taken away from patient care and creating positive dental experiences for children. Free yourself from administrative burdens with TransDental’s specialized pediatric dental billing services and focus your attention on delivering exceptional oral health outcomes for your young patients. From navigating Medicaid/Denti-Cal requirements to age-specific procedure coding and sedation documentation, our team understands the unique complexities of pediatric dental claims.
Our medical billing services adhere strictly to CMS Laws and HIPAA guidelines
TransDental’s pediatric dentistry billing services free you from administrative burdens, allowing you to focus on providing exceptional dental care to your community.
Pediatric and Medicaid Billing Expertise
Maximized Reimbursements Across All Payer Types
Reduced Administrative Burden
Compliance with State and Federal Regulations
Seamless Software Integration
HIPAA-Compliant Security
Dedicated Support Team
Pediatric dental billing requires specialized expertise in age-specific procedure coding and documentation that general dental billing doesn’t encounter. The complexity lies in distinguishing between primary and permanent dentition codes, navigating Medicaid/Denti-Cal and CHIP program requirements with state-specific regulations, managing age-based frequency limitations for fluoride and sealants, documenting behavior management and sedation services, coding pediatric-specific procedures like pulpotomies and stainless steel crowns, and handling early childhood caries treatment protocols that differ significantly from adult restorative dentistry.
TransDental specializes in Medicaid/Denti-Cal compliance, tracking state-specific requirements, age eligibility guidelines, covered services, and documentation standards for pediatric patients. Our specialists understand Treatment Authorization Request (TAR) requirements for extensive treatment, proper coding for EPSDT (Early and Periodic Screening, Diagnostic and Treatment) services, frequency limitations for preventive care, and appeal processes for denied claims with comprehensive clinical justification including treatment narratives, radiographs, and medical necessity documentation to maximize reimbursement while maintaining compliance.
TransDental offers comprehensive pediatric dental billing including Medicaid/Denti-Cal and CHIP enrollment and credentialing, insurance verification and benefits coordination, accurate age-specific CDT code selection for primary and permanent dentition, fluoride and sealant frequency tracking, sedation and behavior management documentation, pre-authorization handling for full-mouth rehabilitation and extensive treatment, pulpotomy and stainless steel crown billing, space maintainer and interceptive orthodontic billing, aggressive accounts receivable follow-up, denied claim appeals with clinical documentation, and detailed financial reporting with practice analytics.
Yes, TransDental manages complete billing for nitrous oxide sedation, oral conscious sedation, and general anesthesia services provided in pediatric dental practices. Our team understands time-based documentation requirements, medical necessity justification for sedation based on patient age and behavior, proper coding for different sedation levels, facility fee billing when applicable, and ensures these services are documented and coded appropriately to maximize reimbursement from both Medicaid and commercial insurance carriers.
TransDental tracks age-based frequency limitations for preventive services including prophylaxis, fluoride applications, and sealants across different insurance carriers and Medicaid programs. We monitor patient birthdays to ensure procedures are billed when patients become eligible, submit supporting documentation for medically necessary exceptions (high caries risk, special healthcare needs), coordinate coverage transitions as children age out of certain programs, and appeal denials with comprehensive clinical justification to maximize preventive care reimbursement.
Yes, TransDental integrates seamlessly with all pediatric practice management systems including Dentrix, Eaglesoft, Open Dental, Curve Dental, and other major platforms. The team handles all technical setup to ensure smooth data flow without disrupting daily operations. All systems maintain HIPAA-compliant security with encrypted protocols, and each practice receives a dedicated account manager with 24/7 access for immediate support on Medicaid/Denti-Cal questions, age-specific coding issues, sedation billing inquiries, and claim status updates.
For every dental claim you’re processing in-house, you’re probably leaving money on the table. When you outsource pediatric dental billing services to TransDental, you get to eliminate administrative burdens, maximize reimbursements across all procedure types and provide financial stability to your practice. Our team of specialists are ready to become your partners in practice success.
Real Results. Real Practices. Real Success.
TransDental fixed denied pediatric claims, boosted collections 29%, and streamlined pre-auths for complex cases. Our team finally has breathing room, and families get answers faster.
They handle pediatric dental and medical billing flawlessly from crowns to OR cases; catching issues early and eliminating payroll costs of in-house billing.
TransDental cut our A/R days from 46 to 26, reduced denials under 3%, and sped up general anesthesia approvals. They’re proactive, fast, and a true partner.
