Build Efficiency and Accountability in Dental Insurance Processes

Key Takeaways:
  • Managing the financial aspect of a dental practice requires meticulous attention to billing and insurance processes.
  • Inaccurate patient information may be the most common billing error when submitting insurance claims.
  • Even minor mistakes can lead to significant financial losses, delayed payments and potential legal issues.


The primary goal for dental practices is to keep our patients happy and healthy. You strive to provide the best clinical care possible and to make patients feel comfortable during their visits. One way you can continue to care for patients at the highest level is to make sure your practice has efficient dental billing processes.  

Navigating billing and insurance administration is challenging. Even minor mistakes can lead to significant financial losses, delayed payments and potential legal issues. To avoid these pitfalls, pay attention to these six common dental billing mistakes, and make plans to prevent them. 

1. Inaccurate Patient Information 

First things first. Correct dental billing starts with entering accurate, complete patient information. This may be the most common billing error when submitting insurance claims. It will lead to a quick claim denial, which ultimately results in delayed payment. The time it takes to find, correct and resubmit the claim costs the practice in more ways than one.  

To avoid this mistake, be sure to collect information from patients prior to their visit. Ask about changes to their personal information, such as a change in address, phone number or employment. Verify their insurance benefits before every appointment. If the patient has an insurance member ID card, this is a great way to ensure the spelling of their name and find out if the insurance carrier includes any middle initials, prefixes or suffixes.  

Insurance verification can be time-consuming and tedious, but implementing a working system will result in more accurate estimates and fewer surprises for the patient. Be sure to check the patient’s status, benefits, limitations and remaining maximum and deductible. 

Dental teams who find themselves too short-staffed to complete the insurance verification process may consider third-party software to gather this information.

This frees the administrative team to spend more time interacting with patients.  

2. Outdated CDT Codes 

The American Dental Association updates the Current Dental Terminology (CDT) manual annually. Changes may include deletions, revisions or additions of dental billing codes. Most Practice Management Software (PMS) requires the office to manually run a software update before using updated codes. 

With the 2024 update, the ADA introduced one new service category, two revisions and 14 additions. These changes allow for more accurate coding and increase the potential for more reimbursements from dental insurance carriers. Dental teams can find current CDT coding resources on the ADA’s website or from other vendors. 

New and updated CDT codes don’t necessarily mean the codes will be covered or reimbursed by insurance carriers. To find that information, get a copy of the provider contract and state insurance laws. 

3. Incomplete Documentation on Insurance Claims 

Another common dental billing mistake is failing to include proper documentation on claim forms. Many codes require offices to attach clinical notes, radiographs, intraoral images and periodontal charting. Without this documentation, the carrier cannot establish whether the procedure was medically necessary. In that case, the claim will be denied and a request for additional information will be sent to the office. 

For example, Scaling and Root Planning (codes D4341 and D4342) requires radiographs showing bone loss, a narrative indicating the presence of periodontal disease, and charting documenting clinical attachment loss. To prevent claim delays, make sure your billing team is familiar with which codes require attachments.  

Some insurance companies also require diagnosis codes, which are referred to as ICD-10 codes. Diagnosis codes are the “why” behind the treatment. Many Affordable Care Act (ACA) and Medicaid plans require such codes. 

4. Miscalculating Out-of-Pocket Costs 

Dental practices that participate with insurance companies must do extra work to calculate the patient’s portion for dental services. Fortunately, today’s dental software makes that process easier. 

Dental practices should start by entering their “standard” or “master” fees. These are the fees the practice charges for every service, not accounting for any insurance allowable. Regardless of participation with insurance carriers, always submit full fees on all insurance claims. 

Next, gather a fee schedule for every insurance you’re contracted with. Enter each of these fee schedules into the PMS. Continue this process by attaching those fee schedules to the insurance carrier they’re associated with. For example, if you are contracted with Company X, make sure to attach their fee schedule to every unique insurance plan they offer. These fee schedules will need updating on an annual basis or as the carrier updates their fees. 

Finally, as you verify insurance coverage prior to patient visits, you’ll enter the plan’s coverage table, which is a list of CDT codes and their respective coverage, usually a percentage of the allowable fee. This coverage table will be unique to each individual or group plan. 

As the office completes procedures and posts them to the patient’s account, the software uses all the information to calculate an accurate patient portion. This allows the office to collect the patient’s payment at the time of service rather than sending costly statements after receiving the insurance payment. 

Practices should also understand other insurance rules that impact out-of-pocket costs. Take care to understand the coordination of benefits when there are multiple payers, and insurance policies like downgrades, exclusions, the missing tooth clause and the Least Expensive Alternative Treatment (LEAT) clause. 

5. No System for Claim Submission & Follow-Up 

Operating procedures are key to practice efficiency. The practice should have a system in place that allows for timely claim submission and follow-up. All insurance claims should be submitted within 24 hours of treatment. This standard requires that other office procedures are efficient. Clinical notes must be completed, and the treating dentist should review the codes prior to submission. 

Once a claim has been submitted, most carriers return payment within two weeks. The team member responsible for insurance claims needs to follow-up on any claims that surpass this deadline. Of course, some payers are slower than others, so your office can determine which carriers have extended deadlines.  

6. Not Updating Your Standard Fees Annually 

One aspect of maintaining a financially healthy dental practice is regularly updating your standard fees. Not doing so will lead to a loss of revenue and impact the practice’s profitability.

Ideally, practices should aim to position their fees in the 80th percentile compared to other practices in the area. 

Offices that find themselves well below this benchmark may need to adjust their fees over time. Once caught up, make it a practice to increase your fees by 5-8% every year. This will help the office keep up with inflation and rising operational costs. 


Managing the financial aspect of a dental practice requires meticulous attention to billing and insurance processes. By proactively addressing the areas above, dental practices can ensure timely reimbursements, maintain profitability and continue to provide high-quality care to patients. Contact an Adams Brown advisor to discuss further.