Dental billing services for US dental practices
An outsourced dental billing company for dentists, specialists and dental groups in all 50 states. Benefits verified before the visit, clean claims filed in 24 to 48 hours, unpaid claims reviewed every 14 days. From 2.29% of collections.
- AAPC and AHIMA certified coders
- HIPAA compliant, BAA signed
- No setup fee, no long-term contract
- D0220Periapical radiograph, first imagePaid
- D2950Core buildup, including any pinsPaid with narrative
- D2740Crown, porcelain or ceramic Paid as D2740 after appeal
- 24-48hFrom completed procedure to claim submission
- 14 daysBetween full insurance AR reviews
- 7-14 daysTo onboard your dental practice
- 2.29%Starting rate. No setup fee, no contract
What dental billing is, and why it is not medical billing
Dental billing is the work of turning completed treatment into payment: verifying benefits, coding procedures with CDT codes, sending the claim with the right attachments, posting what the plan pays, and chasing what it does not.
It looks like medical billing, but the rules are different. Dental plans are benefit plans with a yearly cap. They pay by category, limit how often a service can be done, and quietly substitute a cheaper procedure when the contract allows it. A biller trained only on medical claims will miss most of that.
That is the gap our dental billing specialists fill. They read the full benefit breakdown before the appointment, so the claim is right before it is sent and the patient estimate holds up.
| Item | Dental billing | Medical billing |
|---|---|---|
| Procedure codes | CDT codes (D0120, D2740), updated every January 1 | CPT and HCPCS codes |
| Claim form | ADA Dental Claim Form | CMS-1500 or UB-04 |
| Diagnosis codes | Usually not required, except for medical necessity and some Medicaid plans | ICD-10-CM on every claim |
| Benefit design | Annual maximum, often $1,000 to $2,000, plus waiting periods and frequency limits | Deductible, coinsurance and an out-of-pocket maximum |
| Coverage tiers | Preventive, basic and major, commonly paid at 100, 80 and 50 percent | Based on medical necessity and plan policy |
| Proof required | Radiographs, periodontal charting, photos and narratives | Clinical notes, usually on request |
| Typical denials | Frequency, downgrade, missing tooth clause, waiting period | Authorization, medical necessity, coding edits |
What our dental billing services cover
Outsource the whole dental revenue cycle, or only the parts your front desk cannot keep up with. Every service below is handled by a named team that works inside your practice management software.
Dental insurance verification
Eligibility, annual maximum remaining, deductible met, waiting periods, frequency history, missing tooth clauses and downgrade rules, checked before the patient is in the chair.
Eligibility and benefits verificationCDT coding and claim creation
Procedures coded to the current CDT set with tooth numbers, surfaces, quadrants and arch designations that match the clinical note and the radiograph.
Coding servicesClaim submission with attachments
Claims filed electronically within 24 to 48 hours, with radiographs, periodontal charting, intraoral photos and narratives attached the first time, not after a denial.
Billing servicesPre-treatment estimates
Predeterminations requested for crowns, bridges, implants, periodontal surgery and orthodontics so patients accept treatment with a number they can trust.
Prior authorizationInsurance payment posting
EOBs and ERAs posted line by line with contractual write-offs separated from real adjustments, so your ledger and your production reports agree.
Full RCM managementInsurance AR follow-up
Every unpaid claim reviewed on a 14-day cycle. We call the payer, fix what is wrong and resubmit, starting with the oldest and highest value claims.
Accounts receivableDenial management and appeals
Downgrades, bundling, frequency and medical necessity denials appealed with the documentation the plan's dental consultant actually asks for.
Denial managementMedical cross-coding
Sleep apnea appliances, trauma, biopsies, TMJ treatment and surgical extractions billed to medical plans on the CMS-1500 with ICD-10-CM and CPT codes.
Medical codingDental credentialing and PPO enrollment
CAQH, Delta Dental, MetLife, Cigna, Aetna, Guardian, Medicaid and managed care enrollment, plus re-credentialing so a lapse never stops payment.
Provider credentialingPatient statements and balances
Clear statements, payment plan follow-up and a patient billing line, handled politely and in your practice's name.
Virtual assistant servicesFee schedule and PPO contract review
Your UCR fees and PPO fee schedules compared against what plans actually pay, so you can see which contracts are worth keeping and which write-offs are avoidable.
Practice managementReporting you can act on
Monthly collections, insurance aging, denial causes and production against collection, broken out by provider and by location.
Revenue cycle managementSix signs your dental billing needs outside help
- Insurance claims older than 60 days keep growing on the aging report
- Denials and downgrades are written off because nobody has time to appeal
- Claims go out days after treatment, or without radiographs and narratives
- Patient estimates are often wrong, and balances surprise patients later
- Billing stops when one front desk employee is out or resigns
- Production is up, but collections are flat
| Dental billing KPI | Healthy target | Warning sign |
|---|---|---|
| Net collection ratio | 98% or higher | Consistently below 95% |
| AR older than 90 days | Under 10% of total AR | Above 15% |
| Clean claim rate | 95% or higher | More than 1 in 10 claims reworked |
| Claim submission lag | Within 24 to 48 hours | Weekly batches |
CDT coding that matches the chart, the image and the plan
The American Dental Association revises the CDT code set every year. Our coders work from the current edition and from each payer's processing policies, because a correct code still gets denied when the supporting evidence is missing.
| CDT category | Why claims get denied | How we handle it |
|---|---|---|
| D0100 to D0999Diagnostic | Exams and radiographs inside the plan's frequency window, FMX and panoramic taken too close together | Frequency history pulled during verification and shared with the front desk before scheduling |
| D1000 to D1999Preventive | Prophylaxis billed with active periodontal therapy, fluoride and sealant age limits | Age and frequency limits checked per plan, D1110 and D4910 sequenced correctly |
| D2000 to D2999Restorative | Posterior composites and ceramic crowns downgraded, buildups bundled into the crown, replacement inside five years | Pre-op radiograph, narrative and prior placement date sent with the claim, downgrades appealed when supported |
| D3000 to D3999Endodontics | Retreatment denied as the original provider's responsibility, missing final radiograph | Completion films attached and treatment dates matched to the claim |
| D4000 to D4999Periodontics | D4341 and D4342 denied without charting, quadrant limits, D4910 alternating rules | Full periodontal charting, bone loss evidence and diagnosis attached on first submission |
| D5000 to D6999Prosthodontics and implants | Missing tooth clause, implant exclusions, alternate benefit to a partial denture | Extraction dates documented, predetermination filed, medical plan billed when the cause is medical |
| D7000 to D7999Oral surgery | Surgical extraction downgraded to simple, impaction level disputed, anesthesia units cut | Operative narrative and radiographs matched to the code, anesthesia time recorded in 15 minute units |
| D8000 to D8999Orthodontics | Lifetime maximum confusion, banding date errors, payments that stop mid-treatment | Continuation of care claims and periodic billing schedules built per payer |
| D9000 to D9999Adjunctive services | Occlusal guards, sedation and palliative care denied as not medically necessary | Narratives tied to the diagnosis and the clinical findings in the note |
The dental insurance denials we fix every day
Most dental denials are predictable. They come from something that could have been checked before the appointment or attached to the first claim. Here is what we see, and what we do about each one.
Frequency limitation reached
The plan already paid for that exam, cleaning or radiograph this period, often at another office.
What we do: We request frequency history during verification so the visit is scheduled or the patient is informed before treatment.
Alternate benefit downgrade
The plan pays for amalgam instead of composite, or a metal crown instead of ceramic.
What we do: We flag downgrade clauses on the breakdown, correct the patient estimate and appeal where documentation supports the service provided.
Missing or insufficient documentation
No radiograph, no periodontal charting, no narrative, or an image that does not show the problem.
What we do: Attachments go out with the original claim through your clearinghouse, labeled with tooth number and date.
Missing tooth clause
The tooth was extracted before the patient's coverage began, so the bridge or implant is excluded.
What we do: We ask about prior extractions and coverage effective dates before the treatment plan is presented.
Waiting period not met
Major services are excluded for the first 6 to 12 months of a new policy.
What we do: Waiting periods are captured on every breakdown and noted on the appointment.
Coordination of benefits errors
Dual coverage billed in the wrong order, or the secondary claim sent without the primary EOB.
What we do: We apply the birthday rule and plan type rules, then file the secondary with the primary EOB attached.
Bundling and code inclusion
Core buildups, bases, local anesthesia or pulp caps treated as part of another procedure.
What we do: We code to each payer's published processing policies and appeal bundling that contradicts the CDT descriptor.
Annual maximum exhausted
Treatment completed after the patient's benefits ran out for the year.
What we do: Remaining maximum is rechecked before every major procedure and treatment is phased across benefit years when the patient agrees.
Want the full method? Read our guide to preventing claim denials, or see how our denial management service prioritizes appeals by what is recoverable.
A dental billing company for every type of practice
Each dental specialty has its own codes, payer rules and documentation habits. Your account is staffed by billers who already know yours.
General and family dentistry
Exams, hygiene, restorative and crown and bridge, with frequency tracking and downgrade appeals.
Pediatric dentistry
Medicaid and CHIP dental, sealant and fluoride age limits, behavior management and hospital dentistry.
Orthodontics
Lifetime maximums, banding claims, monthly or quarterly continuation billing and transfer cases.
Oral and maxillofacial surgery
Dental and medical claims side by side, impactions, biopsies, bone grafts, implants and anesthesia units.
Periodontics
Scaling and root planing, osseous surgery, grafting and maintenance, all supported by charting.
Endodontics
Root canal therapy, retreatment, apicoectomy and referral based claims with completion radiographs.
Prosthodontics and implants
Implant bodies, abutments, crowns, dentures and overdentures, including missing tooth clause review.
Dental groups and DSOs
One verification and collections standard across every location, with reporting by office and by provider.
We work with your payers, inside your software
Dental payers we bill
- Delta Dental
- MetLife
- Cigna Dental
- Aetna Dental
- Guardian
- UnitedHealthcare Dental
- Humana Dental
- Principal
- Ameritas
- Sun Life
- Anthem and BCBS dental plans
- GEHA
- DentaQuest
- Liberty Dental Plan
- MCNA Dental
- State Medicaid and CHIP dental programs
- Medicare Advantage dental benefits
- TRICARE Dental Program
Original Medicare covers dental services only when they are tied to a covered medical service, so we check coverage rules before a claim is sent. For new providers, our credentialing team handles PPO and Medicaid enrollment, and our licensing team manages state dental licenses, DEA and CDS registrations.
Dental practice software
- Dentrix
- Dentrix Ascend
- Eaglesoft
- Open Dental
- Curve Dental
- Denticon
- Carestream Dental
No migration and no new dental billing software to buy. We log in with our own user accounts, so every entry is traceable in your audit trail.
What you get from a dedicated dental billing specialist team
AAPC and AHIMA certified coders
Trained on the current CDT code set and on each payer's dental processing policies.
A named account manager
One person who knows your practice, your payers and your open claims. Not a ticket queue.
Insurance AR reviewed every 14 days
Nothing sits past a cycle without a call, a correction or an appeal.
HIPAA compliant, BAA signed first
Access-controlled systems, individual logins and password protected files.
Reporting you can verify
Collections, aging and denial causes every month, by provider and by location.
No setup fee, no long-term contract
Pricing starts at 2.29% of collections. We keep your business by performing.
How outsourcing your dental billing works
Most practices are live in 7 to 14 business days, with no gap in claim submission during the switch.
Free billing review
Send us an aging report and 90 days of EOBs. We show you which claims were denied, downgraded or never followed up.
Access and setup
We sign a BAA, then connect to your practice management software, clearinghouse and payer portals with our own user logins.
Verification starts
Your schedule is verified ahead of each day, with full breakdowns entered where your team already looks for them.
Claims and posting
Claims go out within 24 to 48 hours with attachments. Payments are posted and balanced to your deposits.
AR review every 14 days
Unpaid claims are worked on a fixed cycle, and you receive a monthly report on collections, aging and denial causes.
In-house dental billing compared with ClainetRCM
A good in-house insurance coordinator is valuable and hard to replace. The problem is what happens when that one person is busy, on leave or gone.
| Item | In-house dental billing | Outsourced to ClainetRCM |
|---|---|---|
| Cost | Salary, benefits, training, software and turnover for one or more insurance coordinators | A percentage of what we collect, starting at 2.29%. No setup fee |
| Coverage | Work stops for vacation, sick days and resignations | A team covers your account every working day |
| Claim turnaround | Claims batch up when the front desk is busy with patients | Filed within 24 to 48 hours of the procedure being completed |
| Insurance AR | Followed up when there is time, which is often never | Every unpaid claim reviewed on a 14-day cycle |
| Denials and downgrades | Frequently written off because appeals take too long | Appealed with narratives and images when the documentation supports it |
| Verification depth | Eligibility only, checked the morning of the visit | Full breakdown with frequencies, history, waiting periods and downgrades |
| Reporting | Whatever the practice software produces, if someone runs it | Monthly collections, aging and denial reporting with a named account manager |
| Contract | Hiring and severance risk | No long-term contract. Leave if we do not perform |
Dental billing pricing that starts at 2.29% of collections
We are paid when you are paid. No setup fee, no long-term contract and no charge for the billing review. Your rate depends on claim volume, payer mix and the services you choose.
Remote dental billing in all 50 states
We are a virtual billing company based in Boston, Massachusetts. Our team works with state Medicaid dental programs, regional Delta Dental plans and the commercial payers that matter in your market.
- California dental billing
- Texas dental billing
- Florida dental billing
- New York dental billing
- Pennsylvania dental billing
- Illinois dental billing
- Ohio dental billing
- Georgia dental billing
- North Carolina dental billing
- Michigan dental billing
- New Jersey dental billing
- Virginia dental billing
- Washington dental billing
- Arizona dental billing
- Massachusetts dental billing
- Tennessee dental billing
Dental billing questions, answered
What is dental billing?
Dental billing is the process of turning completed dental treatment into payment. It covers verifying the patient's dental benefits, coding each procedure with CDT codes, sending the claim on the ADA Dental Claim Form with the required radiographs and narratives, posting the insurance payment, following up on unpaid claims, appealing denials and collecting the patient's portion.
What do your dental billing services include?
Insurance verification with full benefit breakdowns, CDT coding, electronic claim submission with attachments, pre-treatment estimates, insurance payment posting, AR follow-up on a 14-day cycle, denial appeals, medical cross-coding, patient statements and dental credentialing. You can outsource the full revenue cycle or only the parts your team cannot keep up with.
How much does outsourced dental billing cost?
ClainetRCM pricing starts at 2.29% of monthly collections. There is no setup fee and no long-term contract. The exact rate depends on claim volume, payer mix and which services you need, and we confirm it in writing after the free billing review.
How is dental billing different from medical billing?
Dental claims use CDT procedure codes on the ADA Dental Claim Form and usually do not require a diagnosis code, while medical claims use CPT and ICD-10-CM codes on the CMS-1500. Dental plans also work differently: annual maximums, waiting periods, frequency limits, missing tooth clauses and alternate benefit downgrades decide what gets paid, and most denials are resolved with radiographs and narratives rather than diagnosis changes.
Can dental procedures be billed to medical insurance?
Yes, when the treatment is medically necessary. Common examples are oral appliances for obstructive sleep apnea, treatment of accidental injury, biopsies and pathology, TMJ disorders, surgical extractions linked to a medical condition and dental clearance before certain medical procedures. These claims need ICD-10-CM diagnosis codes, CPT or HCPCS procedure codes, the CMS-1500 form and a provider who is enrolled with the medical plan.
Which dental billing software do you work with?
We work inside the practice management software you already use, including Dentrix, Dentrix Ascend, Eaglesoft, Open Dental, Curve Dental, Denticon and Carestream Dental. There is no migration and no new software to buy. We use our own user logins so every action is traceable in your audit log.
Do you handle dental credentialing and PPO enrollment?
Yes. We maintain CAQH profiles, submit and track applications with dental PPOs, Medicaid and managed care plans, and manage re-credentialing dates. Commercial plans typically take 90 to 150 days and Medicaid plans 30 to 60 days, so we recommend starting before a new dentist's first day.
Is a remote dental billing company safe for patient data?
We sign a Business Associate Agreement before any protected health information is shared, work through access-controlled systems with individual logins, and send files password protected. Our coders are AAPC and AHIMA certified and trained on HIPAA requirements.
How long does it take to get started?
Most dental practices are fully onboarded in 7 to 14 business days. That covers the BAA, software and portal access, a review of your fee schedules and payer list, and a handover of open claims so nothing ages during the switch.
Do you work with multi-location dental groups and DSOs?
Yes. We apply one verification, claim and follow-up standard across every location and report collections, aging and denial causes by office and by provider, so you can compare performance across the group.
Find out what your insurance AR is hiding
Send us an aging report and we will tell you which claims are still collectible, which denials were never appealed, and what it would take to clean it up.
- You speak with a dental billing specialistNot a sales queue. Someone who works dental claims every day.
- No cost and no obligationYou keep the findings whether or not you hire us.
- ConfidentialWe sign a BAA before any patient information is shared.
- Fast startOnboarding in 7 to 14 business days once you decide.
Prefer to talk? Call +1 (339) 337-9616 or email info@clainetrcm.com.