Expert Dental & Oral Health Medical Billing Services
Maximize your dental practice revenue with specialized billing expertise in CDT coding, medical crossover billing, and dual dental/medical insurance coordination. Our certified dental billing specialists understand the complexities of oral surgery medical necessity, periodontal treatment coding, and orthodontic contract management.
Proven Results
35% Average Revenue Increase
95% First-Pass Claim Rate
48% Reduction in Denials
11 Days Faster Payment Collection
Common Billing Challenges
CDT to CPT Crosswalk Complexity
Converting dental procedures (CDT codes) to medical billing (CPT codes) for medically necessary oral surgery requires specialized expertise and proper documentation.
Medical Necessity Documentation
Proving medical necessity for dental procedures to medical insurance requires extensive clinical documentation and narrative justification.
Dual Billing Optimization
Determining when to bill dental insurance (CDT) vs medical insurance (CPT) for oral surgery and trauma requires expertise in both coding systems.
Pre-Authorization Complexity
Medical insurance pre-authorization for oral surgery procedures requires different documentation than dental pre-auth with longer approval times.
Coordination of Benefits Issues
Managing primary/secondary coverage between dental and medical insurance when both may be responsible creates coordination challenges.
Narrative Report Requirements
Medical insurance claims for dental procedures often require detailed narrative reports explaining clinical necessity that dental billing does not.
Our Solutions
Certified Dental Billing Specialists
Our team includes certified coders with dual expertise in both CDT dental coding and CPT medical coding for oral surgery crossovers.
Expert CDT and CPT crosswalk coding
Medical necessity documentation support
Oral surgery and trauma billing expertise
Maximized reimbursement through proper code selection
Medical Crossover Expertise
Specialized knowledge of when dental procedures qualify for medical insurance billing with proper CPT code conversion and ICD-10 diagnosis linking.
Identification of medical crossover opportunities
Proper diagnosis code linking (ICD-10)
Narrative report preparation assistance
Higher reimbursement from medical insurance
Dual Billing Optimization Systems
Advanced systems identify procedures that qualify for medical billing and automatically track coordination of benefits between dental and medical insurance.
Automated medical billing opportunity identification
Primary/secondary insurance coordination
Dual claim tracking and follow-up
Reduced coordination of benefits errors
Pre-Authorization Management
Dedicated team handles pre-authorizations for both dental and medical insurance with proper clinical documentation for approval.
Faster approval times for oral surgery
Higher pre-auth approval rates
Reduced administrative burden on staff
Improved patient treatment scheduling
Specialized Services
Routine Dental Billing
Complete CDT coding and billing for preventive, restorative, and periodontal procedures through dental insurance.
Preventive services (D1000)
Restorative procedures (D2000)
Periodontal treatment (D4000)
Endodontic services (D3000)
Oral Surgery Medical Crossover
Specialized billing for medically necessary oral surgery using CPT codes for medical insurance reimbursement.
Surgical extractions (CPT 41899)
TMJ procedures
Trauma and fracture repair
Biopsy and pathology billing
Periodontal Procedure Billing
Expert coding for surgical and non-surgical periodontal treatments with proper documentation and medical crossover identification.
Scaling and root planing
Periodontal surgery (D4000)
Gingival grafting
Bone grafting procedures
Orthodontic Billing Management
Monthly payment tracking and insurance billing for orthodontic treatment plans with proper contract management.
Initial placement billing
Monthly contract tracking
Progress billing
Retention phase coding
Common CPT Codes Reference
Key dental billing codes span both CDT and CPT systems. CDT codes include D0120 (periodic oral evaluation), D0150 (comprehensive oral evaluation), D2750 (porcelain crown), D4341 (scaling and root planing), D7140 (extraction erupted tooth), D7210 (surgical extraction), D7240 (impacted tooth removal), and D6010 (implant body). Medical crossover CPT codes include 21210 (bone graft facial augmentation), 40808 (biopsy vestibule of mouth), 41112 (excision lesion tongue), 21244 (reconstruction mandible), and 42820 (tonsillectomy). Understanding the CDT-to-CPT crosswalk is critical for maximizing revenue from medically necessary procedures.
Expert Billing Insights
CDT to CPT Crosswalk: Unlocking Medical Insurance Revenue
Many dental procedures have medical crossover potential that practices routinely miss, including TMJ treatment, oral pathology biopsies, trauma repair, and sleep apnea appliance fabrication. The key to successful medical crossover billing is proper ICD-10 diagnosis linking—medical insurance requires medical diagnoses, not dental codes. Practices that implement systematic crossover identification recover 25-40% of previously unbilled revenue from medically necessary oral procedures.
TMJ, oral pathology, trauma, and sleep apnea procedures are the highest-value crossover opportunities
Medical insurance requires ICD-10 diagnoses—dental diagnosis codes alone will result in denials
Narrative reports documenting medical necessity are required for all medical crossover claims
Systematic crossover identification can recover 25-40% of previously unbilled revenue
Dental vs Medical Insurance Coordination: Maximizing Dual Coverage
When patients carry both dental and medical insurance, coordination of benefits rules determine which payer is primary for oral surgery procedures. Medical insurance is typically primary for trauma, pathology, and medically necessary extractions before radiation therapy. Understanding which procedures should be billed to medical first—and how to properly bill the dental plan as secondary—prevents duplicate payment issues and maximizes total reimbursement.
Bill medical insurance first for trauma, pathology, biopsies, and pre-radiation extractions
Dental insurance becomes secondary and may cover remaining patient responsibility
Pre-determination from dental insurance is separate from medical pre-authorization
Document coordination of benefits determinations to prevent duplicate payment recovery
Pre-authorization timelines differ drastically between dental insurance (24-48 hours typical) and medical insurance (7-14 business days). Clinical documentation requirements also diverge—medical pre-auth demands operative notes, diagnostic imaging, and narrative justification while dental pre-auth typically requires only radiographs and a treatment plan. When dental insurance denies a procedure, medical crossover billing may provide an alternative coverage pathway with proper documentation.
Medical pre-auth takes 7-14 business days vs 24-48 hours for dental—plan submission timing accordingly
Medical pre-auth requires operative notes, imaging, and narrative vs dental's radiograph-based review
Dental denial can trigger medical crossover billing with proper diagnosis recoding
Predetermination (estimate of benefits) differs from preauthorization (approval to treat)
Payer-Specific Billing Tips
Dental Insurance (Delta Dental/MetLife/Cigna)
Annual maximums ($1,000-$2,500) require strategic treatment phasing across benefit years
Waiting periods of 6-12 months for major procedures affect treatment planning
Frequency limitations for preventive care (2 cleanings/year) must be tracked to avoid denials
UCR-based vs fee schedule reimbursement varies by plan—verify contracted rates annually
Medical Insurance (Crossover Billing)
Dentists must be credentialed with medical insurance to bill CPT codes for crossover procedures
Medical necessity documentation must reference medical conditions, not dental diagnoses
Pre-authorization for oral surgery through medical insurance requires different clinical documentation
Place of service codes affect reimbursement—office (11) vs ASC (24) vs hospital outpatient (22)
Medicare Part B (Limited Dental)
Medicare covers dental services integral to covered medical procedures (jaw fractures, biopsies, pre-radiation extractions)
Hospital-based oral surgery follows OPPS payment rates with facility and professional components
ABN required for non-covered routine dental services performed in conjunction with covered procedures
Medicare Advantage plans may offer expanded dental benefits beyond traditional Medicare
Medicaid Dental Benefits
Adult dental coverage varies dramatically by state—only about half of states offer comprehensive adult dental
Pediatric dental is mandatory under EPSDT with comprehensive coverage including orthodontics
Prior authorization requirements and covered procedure lists differ by state Medicaid program
Some states require CDT coding exclusively while others accept CPT for oral surgery procedures
Client Testimonial
Managing both dental and medical billing for our oral surgery practice was incredibly
challenging. Medtransic's team has expertise in both CDT and CPT coding, and they've
helped us identify medical crossover opportunities that increased our revenue by 40%.
Their knowledge of medical necessity documentation and pre-authorization management
has streamlined our entire billing process.