Frequency limit exceeded
A prophylaxis, exam or bitewing set was billed inside the plan's interval. Core MB checks service history at verification and schedules recall billing around the limit instead of writing it off.
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Dental and oral surgery billing services
Dental and oral surgery billing runs on two code sets and two claim forms. Routine care bills CDT codes on the ADA form with frequency limits and waiting periods, while trauma, pathology, TMJ and medically necessary oral surgery can bill the medical plan with CPT and ICD-10. Claims pay when the right plan is billed first and attachments are complete.
What makes dental billing different
Dental billing has its own code set, its own claim form and plan rules that look nothing like medical insurance.
- CDT codes drive most claims: D0120 and D0150 exams, D0210 and D0274 radiographs, D1110 prophylaxis, D4341 and D4342 scaling by quadrant, D2740 and D2750 crowns, and D7140 through D7241 extractions, each with tooth, surface or quadrant.
- Oral surgery cross-coding sends impacted third molars, biopsies, facial trauma and pathology to the medical plan with CPT such as 41899 unlisted dental or 21xxx facial codes and ICD-10 from K00 through K08, dental plan secondary.
- Sedation bills D9222 and D9223 for deep sedation or general anesthesia and D9239 and D9243 for IV moderate sedation in fifteen-minute increments, and many plans only cover it with documented age, disability or procedure complexity.
- Periodontal, crown and implant claims need narratives, pre-op radiographs and perio charting attached, and predeterminations are the only way to confirm coverage before treatment on plans with missing tooth clauses and downgrade provisions.
Denials we see most in dental
Every denial gets a root cause, a fix and a feedback loop, so the same denial stops coming back.
Attachment missing
Crowns, scaling and implants were denied for no radiograph, perio chart or narrative. Core MB sends the required attachments electronically with the first submission based on each payer's documented list.
Wrong plan billed first
Medically necessary oral surgery went to the dental plan and was denied, or the medical plan wants dental exhaustion first. Core MB determines primacy during verification and bills in the right order with the EOB.
How Core MB bills for dental
Core MB bills dental and oral surgery practices with staff who work CDT and CPT side by side, run predeterminations before treatment and manage the attachments each payer asks for. Credentialing for new dentists and oral surgeons runs in the same client portal. Credentialing for new providers runs in the same system, tracked live in your client portal.
- Verification records frequency limits, waiting periods, missing tooth clauses and downgrade rules before the patient is seated.
- Oral surgery claims are reviewed for medical cross-coding and billed to the medical plan first when the indication supports it.
- Attachments, narratives and tooth charting are sent with the original claim so denials for missing records do not occur.
Everything in the service
Verification, coding review, predeterminations, scrubbing, follow-up, denial work, posting, AR, statements and reporting are all part of Core MB's dental service, with credentialing in the same portal.
- Insurance verification and eligibility checks
- Charge entry and specialty-specific coding review
- Claim scrubbing and electronic submission
- Payer follow-up on every open claim
- Denial management and appeals
- Payment posting and reconciliation
- Accounts receivable recovery
- Patient statements and balance support
- Monthly reporting you can read in five minutes
- Provider credentialing and payer enrollment
Dental billing questions
Which oral surgery procedures can we bill to the medical plan?
Procedures with a medical indication: impacted third molars with pathology or infection, biopsies, facial trauma repairs, cysts, TMJ surgery, sleep apnea appliances and dental work required before transplant or cancer treatment. Core MB reviews the chart for the medical diagnosis, cross-codes to CPT and ICD-10, and bills the dental plan secondary with the medical EOB.
Why do crowns keep coming back as paid at a lower rate than we charged?
Many PPO plans downgrade posterior crowns and composites to the metallic or amalgam allowance under an alternate benefit provision. Core MB identifies downgrade rules at verification so the front desk can quote the patient portion correctly, and files appeals with radiographs when the plan's own criteria support the material used.
Our oral surgeon uses general anesthesia on anxious adult patients. Is it covered?
Dental plans usually cover D9223 only for documented conditions such as impacted teeth, developmental disability or an extensive procedure, and some medical plans cover anesthesia for dental care under specific criteria. Core MB checks both plans, documents the indication and time increments, and sets patient expectations before the appointment.
How do we get started with Core MB for dental billing?
Complete the quote form with your practice type, PPO and Medicaid mix and whether you bill medical plans today. We review current claims and set a start date, and the transition runs alongside your current billing so recall and treatment plans continue uninterrupted. Credentialing for new dentists can start at the same time.
Dental and oral surgery billing across both code sets
Core MB bills CDT and medical claims for dental practices and oral surgeons, handles attachments and predeterminations, and keeps patient balances predictable.