Billing an Evaluation and Perio Recall on the Same Day

Can D0120 be billed on the same day as periodontal maintenance?

Billing Palliative and a Limited Evaluation on the Same Day

Can palliative treatment (D9110) be billed on the same date as a limited oral evaluation (D0140)?

Plan Limitations for Limited Evaluation

How often are limited oral evaluations (D0140) covered?

Plan Limitations for Oral Evaluation

How often will dental plans pay for D0150?

Reporting Case Presentation

Complex cases often require a lengthy consultation with the patient to discuss the diagnosis and treatment options. Can this be billed separately?

Reporting Problem Focused Evaluations

How often do dental plans typically cover D0160? Do we actually need to submit a report?

Prompt Payment Laws - How Long Do Insurance Companies Have to Pay Claims?

Just how long does an insurance company have to respond to a dental claim? I called the carrier to follow up on an unpaid claim and was told that the plan is self-funded, and they can't pay the claim until the employer funds the plan. What should I do?

Re-evaluation Frequencies

How often do dental plans pay for D0170?

D0180 and SRP (D4341 or D4342) or D4910 on the Same Day

Can D0180 be billed the same day as other periodontal services, and how often will it be covered?

Cone Beam CT

We are fairly new to billing cone beam images to insurance companies. So far, all our claims have been denied. Are you aware of any dental plans that cover the cone beam CT codes?

Gramm Crown

Our doctor recently started using Gramm crowns. How are they different from other crowns, and what code should I use?

Pulpotomy vs. Pulpal Debridement

How does a pulpotomy differ from pupal debridement?

Root Canals Reporting Date

When should root canals be reported?

Incomplete Endodontic Therapy

Will dental plans pay for incomplete endodontic therapy?

Root Canal on Primary Molar

What code can I use when doing a root canal on a primary molar?

Free Soft Tissue Graft

How does a free soft tissue graft differ from other grafts?

SRP and Prophy

Can we perform one or two quadrants of SRP (D4341) and a prophy (D1110) on the same day if that is all the root planing that is needed?

Perio Protect Trays™

What code is used to report Perio Protect Trays™?

Crown Lengthening vs. Anatomic Crown Exposure

How does crown lengthening differ from anatomic crown exposure?

Coding Cusil Partial Dentures

We have a patient who will need a CuSil® partial. We are keeping seven teeth, and the partial will have rubber gaskets that sit over the retained teeth. The lab costs on this are more than a regular partial. What code should we bill?

Uncovering Implants

What code can we bill when uncovering the implant and placing a healing cap?

Mini-implants

What dental code do we use for mini-implants used to support a removeable partial or denture?

Implant vs. Abutment Supported Crowns

We billed D6065 for an implant supported porcelain crown and D6056 for the abutment. Both were denied saying we used incorrect codes. I called the dental plan to ask what code we should have used, and they refused to tell me. Any suggestions?

Radiographic vs. Surgical Implant Indexes

What is the difference between a radiographic index and a surgical implant index? How is D6190 different from D5982 and D5988?

Implant Bridge

How do we code a bridge supported by implants?

Maryland Bridge

How do we bill a Maryland Bridge?

Recementing

What exactly are you recementing? Natural tooth or implant-type crowns?

Cantilever Bridge

How do we code a cantilever bridge?

Operculectomy or Excision of Pericoronal Gingiva

What code reports when a dentist surgically removes the mucosal flap that partially or completely covers an unerupted tooth?

Desensitizing

What code can report the application of a desensitizing medicament?

Dry Socket Treatment

What is the best way to code for dry socket treatment?

What fees should we report on claims?

Should we submit our full fees or our contracted PPO fees on dental claims?

Soft Tissue Grafts

Should soft tissue grafts be billed per site or per tooth?

Locum Tenens Dental Providers

When a locum tenens dentist fills in for a dentist, who should be listed as the treating dentist when the locum tenens is not a contracted provider for the same dental plans as the regular dentist?

Reporting Removal of Multiple Tori

When a patient has tori removed from the lower left and lower right quadrant, is it appropiate to report D7473 (Removal of Torus Mandibularis) twice, or is a single use of the code intended to cover one or more tori?

Records Retention

When a patient dies, how long are we required to keep his/her dental records?

Non-covered Cosmetic Services

I was reading our state law regarding non-covered services, and it raises several questions. If we are a preferred provider and a Delta Dental patient wants crowns or veneers on #8 and #9 strictly for cosmetic reasons, can we charge the patient our full fee? Or are we still limited to our Delta Dental contracted fee?

Coverage Issues - Bridge and Pontic

If a patient has a missing tooth clause, will the insurance pay for the retainers (abutments) on the bridge and not the missing tooth?

Laser Reporting for Periodontal Procedures

How do I report the use of a laser for periodontal procedures?

Do evaluations (exams) include periodontal screening?

When should a periodontal screening be done with an evaluation?

Child vs. Adult Prophylaxis

What are the age ranges for the child and for the adult prophy?

Can crowns never seated be billed?

Can I bill for a crown that the lab delivered but was never seated?

Cantilever Bridge

We placed a cantilever bridge on a patient, and I do not know what code to use on the claim form. Do I need to include a narrative? I am new to dentistry and am not familiar with some of the procedures I am billing.

Missing Tooth Clause

A patient's bridge was denied due to a missing tooth clause. When our patient called the carrier, she was told that her plan would allow for an alternate benefit. When asked what that might be, the phone representative would not tell her. What type of information can we provide to help her receive an alternate benefit?

How Often Should We Perio Chart?

How often should a full periodontal charting be performed on an adult patient, and what code should we report?

How Often Should We Spot Probe?

How often should we spot probe, and what code should we report?

Supernumerary Tooth Extractions

We extracted a supernumerary tooth between #8 and #9 on an 8-year-old child. Could you please let us know how we should bill this? We know the CDT code (D7140) but do not know what tooth number to report.

Autogeous Bone Grafts and Infuse Bone Grafts

Our doctor would like to place autogenous bone grafts and Infuse bone grafts. What codes should I use to report these procedures?

Medicare FAQs

What dental services are covered by Medicare?

Crown Narrative - Decay Not Obvious on X-ray

What kind of narrative should I send in the following situation? Tooth #30 has an existing occlusal amalgam with recurrent mesial decay visible on the x-ray and Class V wrap around decay that is not visible on the x-ray. In the radiograph it looks like the tooth needs just a two surface restoration. However, all the cusps are undermined once the decay is excavated, and the tooth is too weak to support an amalgam/composite restoration. A crown is clearly needed, but it is always denied.

TAP Snore Guard to Medical

How do I bill a patient's medical insurance for a TAP snore guard appliance?

Alternate Benefits

How can we obtain an alternate benefit for a patient?

All-on-4

How should an All-on-4 treatment be reported?

ACA and COB

Is the ACA plan primary or secondary?

ACA and Orthodontics

Do ACA plans cover orthodontics for children?

Medicaid Balance Billing

May I balance bill a Medicaid patient for covered services?

Medicaid Overpayments

Do I have to refund Medicaid when they pay the normal fee schedule but Medicaid is secondary? The EOB from Medicaid states the claim was processed as secondary, yet they ignored the primary payment?

Medicaid and Diagnoses Codes

Other than needing diagnoses codes for dental and medical claims, when might I need to provide an ICD diagnosis code?

Fee Splitting with Specialists

An oral surgeon uses our office and pays us 20 percent of production (versus a flat daily rental rate) for the use of our facility. Is this legal?

Non-covered Medicaid Procedures

Can a Medicaid patient pay directly for veneers, orthodontics, pediatric partials, etc., which are considered non-covered procedures?

Retroactive Medicaid Coverage

If a patient presents a Medicaid card months after treatment has been rendered, am I required to submit the claim to Medicaid?

Alternate Benefits

How can we obtain an alternate benefit for a patient?

Assignment of Benefits

Who must sign the assignment of benefits? Is it necessary to have the insurance subscriber sign an assignment of benefits and release of dental information form if the spouse and children are patients, but the subscriber is not?

Copay Forgiveness

How do we handle copays or discounts for clergy, military, etc.?

Charging for a Failed Crown

A crown is prepped, delivered, and reimbursed by the payer. The crown fails shortly thereafter, the tooth is extracted and the patient needs a bridge. The doctor wants to offer a treatment credit to the patient for the failed crown. How should this be handled?