Dental Billing for Dummies: Coding, Creating, and Submitting Clean Claims

In the first article of this series, we focused on the foundation of dental billing: setting up your system, capturing accurate patient data, and verifying eligibility. In this installment, we move into the heart of the process. Clean claims depend on accurate documentation, correct CDT coding, thoughtful treatment planning, and timely submission.

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Dental Billing for Dummies: Why documentation and coding matter

Every claim submitted to an insurance carrier must be supported by detailed documentation. Clinical notes, radiographs, and diagnostic records serve as proof of necessity and accuracy. When documentation is incomplete or vague, claims are more likely to be denied or delayed. In fact, denials cost dental practices both time and money, requiring staff to rework claims that could have been approved the first time [1].

Coding is equally important. The American Dental Association (ADA) maintains Current Dental Terminology (CDT) codes, which are updated annually [2]. These codes describe procedures consistently across the industry. Misused or outdated codes not only cause denials but may also create compliance risks.

Step 4: Document clinical care and apply CDT codes

Capture accurate clinical documentation

• Write detailed clinical notes that describe diagnosis, treatment performed, and justification for the procedure.

• Include supporting attachments such as radiographs, intraoral photographs, and periodontal charting.

• When insurers require narratives, use concise, factual language that explains why the procedure was necessary.

Apply CDT codes correctly

• Assign the most specific CDT code available. For example, a one-surface filling on a posterior tooth requires a different code than a two-surface filling on an anterior tooth.

• Confirm that your practice management software is updated with the latest CDT code set each January [2].

• For medically necessary cases, consider whether an ICD-10 diagnosis code is also required for claim submission [3].

Avoid common pitfalls

• Do not “upcode” by using a more expensive code than justified. This creates compliance risks and may trigger audits.

• Watch for “bundling” errors, where carriers combine multiple procedures into a single code. Documentation helps appeal such denials if appropriate [4].

Step 5: Build treatment plans and financial estimates

Accurate treatment planning is not only clinical but also financial. Patients want to understand what their insurance will cover and what they will owe.

1. Sequence the treatment plan

   1. Organize procedures into logical phases: urgent care, restorative care, and elective services. Sequencing helps insurance and patient financing align with clinical priorities.

2. Estimate insurance portions

   1. Use the patient’s verified benefits to calculate how much of each procedure will be covered. Subtract deductible amounts and factor in annual maximums.

3. Communicate clearly with patients

   1. Present a written estimate that shows your fee, the insurance portion, and the patient’s expected responsibility. Collect consent and discuss payment options to avoid confusion later [5].

By creating accurate treatment plans, you reduce financial surprises and build patient trust.

Step 6: Create and submit clean claims

Completing the ADA claim form

The ADA Dental Claim Form is the industry standard for insurance submissions [6]. Each section must be filled out completely and accurately:

• Patient and subscriber information

• Treating dentist information

• Procedure codes, dates of service, tooth numbers or surfaces, and fees

• Provider signature and NPI number

Attaching supporting documentation

Certain procedures, such as crowns, scaling and root planing, or implants, often require attachments. Always include:

• Radiographs (digital or film)

• Periodontal charting

• Clinical narratives explaining necessity

Submitting a claim without required attachments is one of the leading causes of denials [1].

Submitting electronically

Most practices use clearinghouses to transmit claims. Electronic submission reduces turnaround times and improves tracking. Submit claims within one to two business days of treatment for the best results [7].

Clean claim checklist

A clean claim is one that can be processed without additional information. Before submitting, confirm:

• Patient data matches payer records

• Correct CDT codes are listed

• Attachments and narratives are included

• Fees match the practice’s fee schedule

Practices that consistently submit clean claims enjoy higher first-pass acceptance rates and improved cash flow [8].

What comes next in the series

You now understand how accurate documentation, proper coding, and clean claim submission build the core of effective dental billing. In Article 3: Dental Billing for Dummies — Tracking Claims, Payments, and Rejections, we will cover:

• How to monitor claims after submission

• Strategies for handling rejections and denials

• Posting payments, write-offs, and reconciling with bank deposits

• Coordinating secondary billing and benefits

By mastering these steps, your practice will minimize delays and strengthen collections.

References

1. Dental ClaimSupport. “The Ultimate Guide to Dental Billing.” Link

2. American Dental Association. “Current Dental Terminology (CDT).” Link

3. Outsource Strategies International. “Overview of the Dental Billing Process.” Link

4. Transcure. “Understanding the Dental Billing Process with CDT Code Sheet.” Link

5. PMN Inc. “Dental Billing for Dummies.” Link

6. American Dental Association. “Dental Claim Form.” Link

7. Dental ClaimSupport. “How Dental Billing Works.” Link

8. IRCM. “Dental Billing Guide.” Link