Dental Billing
CDT coding, predeterminations and dental–medical crossover billing — dental billing that gets claims paid the first time.
Dental billing runs on its own code set, its own claim logic and benefit rules built around annual maximums and frequency limits — nothing like medical billing with different codes. Elite Bill Care's dental billing service handles dental practices and the dental side of multi-specialty groups with that separate discipline.
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Dental billing specifics
- CDT coding — current Dental Procedure Codes applied precisely (prophylaxis vs. periodontal maintenance, D1110 vs. D4910 being the classic revenue-and-audit distinction).
- Frequency and limitation management — exams, cleanings, fluoride, X-rays and major work all carry plan-specific frequency limits and waiting periods; verified before treatment through eligibility checks so the patient conversation happens before the chair, not after a denial.
- Predeterminations — pre-treatment estimates for major work (crowns, implants, perio surgery) submitted and tracked so treatment plans are presented with real numbers.
- Narratives and attachments — the clinical narratives, X-rays and perio charting that dental payers require for crowns, build-ups, implants and periodontal claims, attached correctly the first time.
- Annual maximums and downgrades — tracked per patient, including alternate-benefit (LEAT) downgrades on posterior composites, so patient balances are explained, not surprising.
- Dental–medical crossover — where treatment is medically billable (oral surgery, trauma, sleep-apnea appliances, certain TMD care), claims prepared for medical payers under medical rules — a specialty of our coding support.
How we run it
Claims go out daily on the ADA claim format through your clearinghouse, EOBs are posted line-by-line so downgrades and write-offs are visible per procedure, and dental-specific denial patterns (missing narratives, frequency, downgrade disputes) are worked through denial management. See our full medical billing services for the shared operation.
Frequently asked questions
Do you bill both dental plans and medical plans for dental practices?
Yes — dental benefits under CDT rules, and medically billable services to medical payers where coverage genuinely applies, each under its own rules.
Can you handle orthodontics billing?
Yes — case-rate and installment billing for ortho with the down-payment and monthly claim rhythm ortho contracts use, plus lifetime-maximum tracking.
Do you verify benefits before treatment?
Yes — remaining maximum, frequency status and waiting periods are part of the pre-treatment check, which is where dental billing is won.