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Dental Billing Services
Dental billing is CDT codes, not CPT. A medical plan pays only when the service meets a medical benefit. Vector Medical Billing, in Jamaica, New York, puts the tooth number on the dental claim, watches the plan’s frequency limit, and does not send the same service on two forms inside the system you already use.
98%Published NCR
24hClaim Submission
BAASigned with every client
AAPCCertified coders
AHIMACertified coders
E&OErrors and omissions insured
50 StatesRemote billing nationwide
Monthly fee
What dental billing services include
Full-cycle RCM for general dentistry and oral surgery that bills a dental benefit — CDT on the dental claim, medical only when the benefit is medical.
The operating cycle matches medical billing services: eligibility, charge capture from the chart, CDT coding, scrub, clearinghouse submission, payment posting, denial management, and A/R follow-up. The scrub watches tooth number and surface, missing radiographs, frequency limits, predetermination, and whether a routine dental service was sent to a medical plan.
In scope: diagnostic, preventive, restorative, endodontic, periodontal, prosthodontic, and oral-surgery CDT lines on the dental benefit; narratives and images the plan asks for; and a medical claim when trauma, infection, fracture, or hospital oral surgery meets that medical benefit. Orthodontic banding and periodic ortho visits are a separate page. This is not a medical office visit with a tooth diagram added.
Dental is priced as a percentage of net collections because CDT detail, frequency limits, and crossover take extra scrub time. The written rate follows procedure mix — see pricing. Credentialing with each dental payer, a retrospective coding audit, MIPS, and out-of-network / IDR stay separate engagements.
What sits on this dental fee
- CDT on the dental claim, with tooth and surface
- Medical crossover only when the benefit is medical
- HIPAA workflows, a signed BAA, and PHI limited to staff on the account
Where dental claims fail
Patterns dental-payer manuals and ADA claim guidance keep naming.
CPT on a dental benefit
A filling or extraction sent as a medical procedure code to the dental plan. Or both a CDT code and a CPT code listed for the same service, so the payer processes one and rejects the other as a duplicate.
Hub rule: CDT, not CPT, on the dental claim.
Missing tooth or a second cleaning too soon
No tooth number or surface on a restoration. A prophy inside the plan’s frequency window. A crown without the radiograph or narrative that plan requires. An unspecified code when a specific CDT exists.
The chart has the tooth. The plan has the interval. Both have to be on the claim.
Routine dentistry sent to medical
A cleaning or a simple restoration filed to the medical plan because the patient has no dental benefit. Two claim forms for one extraction. Oral surgery billed to medical first when that plan requires the dental benefit to process first.
A medical plan pays only when the service meets a medical benefit.
CDT · not CPT
CDT codes, not CPT
Hub language made operational: the dental benefit reads Current Dental Terminology on the dental claim.
Preventive, restorative, and surgical dentistry billed to a dental plan uses the current CDT code on the ADA dental claim form or the electronic 837D. A restoration needs the tooth number and the surfaces. A periodontal or oral-surgery line needs the quadrant, arch, or tooth the code describes. Use the most specific CDT code. An unspecified code delays the claim when a precise one exists. Do not translate the visit into a medical office code because the front desk is used to CPT.
File the charge once. Do not send an ADA form and a CMS-1500 for the same service, and do not list both the CDT code and a CPT code for that service on one claim. Payers treat the second submission as a duplicate, or they keep the CDT line and drop the CPT line. OSHA or infection-control fees are not a separate patient charge on top of the procedure.
Dental-claim checklist
- Current CDT code, one claim form
- Tooth, surface, or area filled in
- No CPT twin of the same service
Frequency, predetermination, and the image
Eligibility is not the same as “this crown is allowed this year.”
Plan intervals
Dental plans limit how often an exam, cleaning, bitewing series, or crown replacement is paid. One plan may allow two cleanings in a benefit year. Another may require six months between them, counted to the day. A replacement denture or crown often has a multi-year rule unless the chart shows the old one is broken beyond repair. Bill inside the interval the plan printed, or the line denies even when the CDT code is correct.
Predetermination and attachments
Crowns, dentures, periodontal surgery, and many oral-surgery lines need a predetermination or prior authorization before the appointment, not after the denial. The request needs the narrative: what is wrong, why this procedure, and the radiograph or photo that plan lists. A predetermination is not a guarantee of payment if eligibility changes. Attachments that never upload are a common “missing information” denial.
When a medical plan pays
The service has to meet a medical benefit. The form has to match the code set that plan accepts.
Medical benefit, not a dental code swap
Trauma, infection, jaw fracture, and some hospital or emergency oral-surgery care can meet a medical benefit. A periodic exam and a filling do not. If the patient also has dental coverage, many plans want the dental benefit to process oral surgery first. Do not open with a medical claim when the contract says dental is primary.
Which code the medical plan wants
Some medical plans accept a CDT code on the medical claim. Others reject CDT and want CPT, or an unlisted procedure code plus the operative note and the CDT description. Extractions are often returned when they are filed as an unlisted CPT instead of the extraction CDT the dental plan uses. Ask that payer before the first crossover, and do not put both codes on one form.
Hospital oral surgery
An oral surgeon called for infection, fracture, or trauma may bill evaluation and management on a medical claim under CPT rules, separate from the dental extraction codes. Facility fees stay on the hospital claim. Sedation has its own CDT time increments when the dental plan covers it — first 15 minutes, then each additional 15 — not a flat “anesthesia” line.
Dental code families this service works
Illustrative anchors — the chart and that plan’s benefit decide the line. Orthodontic banding is not on this page.
| Work type | Example | What to check | Common failure if skipped |
|---|---|---|---|
| Exam / cleaning | Diagnostic and preventive CDT | Frequency window | Second prophy too soon |
| Radiographs | Bitewing / panoramic CDT | Attached when required | Missing image |
| Restoration | CDT by surfaces | Tooth and surfaces | No tooth number |
| Crown / denture | Prosthodontic CDT | Predetermination; replacement rule | Filed after the denial |
| Extraction | CDT, not an unlisted CPT | Impaction diagnosis if impacted | 41899 sent to dental |
| Sedation | First 15 min, then add-on | Minutes documented | One flat unit |
| Medical crossover | CPT or CDT, one form | Medical benefit actually covers it | Cleaning sent to medical |
| Same service twice | ADA or CMS-1500, not both | One code set | Duplicate denial |
This page does not invent a dental denial percentage. The free audit reads your CDT lines, missing teeth, and crossover claims on the sample you send.
What a free audit line looks like
Illustrative composite only — not a client result and not a promised recovery.
| Field | Example entry |
|---|---|
| Documented service | Three-surface restoration, tooth 14. Patient also had a cleaning 4 months ago. Plan allows a cleaning every 6 months. No trauma. |
| Billed codes | ADA claim with the restoration CDT and no tooth number, plus a CMS-1500 with an unlisted dental CPT for the same filling, sent to the medical plan |
| Issue found | Tooth and surfaces missing. Same service on two forms. Medical plan has no medical benefit for a routine restoration. |
| Recommended correction | One ADA claim: the specific restoration CDT, tooth 14, surfaces MOD. Do not bill medical. Leave the cleaning off until the 6-month date. |
| Related check | Radiograph attached if that plan requires it for a multi-surface restoration |
| Why it matters | A CPT twin and a medical filing of routine dentistry deny or duplicate — caught in scrub or flagged in the free audit |
Request a Free Audit with recent claims, EOBs, and a few charts. We map CDT versus medical crossover on your file — not this composite.
How Vector runs dental billing
Which benefit pays first — then the same revenue cycle.
1
Assign dental RCM
Coder and biller who already keep CDT off the medical form unless the benefit is medical.
2
Reconcile and code
Charge entry and coding from the chart — queries when the tooth or the image is missing.
4
Post and report
Payment posting, denial work, A/R aging, monthly RCM report by dental benefit versus medical crossover.
Not inside the dental percentage
Related work stays separate so the quote matches the job.
Facility fees
Hospital or surgery-center facility charges stay on the facility claim. We bill the professional dental and oral-surgery lines your office owns.
Credentialing / audit
Credentialing with dental plans and a retrospective coding audit of CDT and crossover are separate when scoped.
Underpay / OON
Underpayment recovery and OON / IDR stay separate when the dispute path is not ordinary denial work.
How dental billing is priced
Percentage of dollars that land — not a flat fee per claim that ignores frequency denials.
Written rate
Dental is priced as a percentage of net collections because CDT detail, frequency limits, and medical crossover take more scrub time. No setup fee on the monthly cycle. Month to month. The written rate follows procedure mix and how much of the cycle you hand over.
See pricing or request a written rate after the free audit.
What we need to start
Practice-system access, the dental plans you bill, how often cases cross to medical, open A/R if you are leaving another biller, and a sample of frequency or crossover denials. Switching usually overlaps so claim submission does not stop. See EHR integration if access setup needs a separate quote.
Audit the fillings that went out without a tooth number
Send monthly procedure volume, whether you bill medical crossover, system name, and a sample of frequency or duplicate denials. We reply with what the open A/R shows, whether the monthly fee fits, and a written rate — without inventing a clean-claim percentage.
Written
Monthly rate
98%
Published NCR
50
US States
BAA
Every Client
Dental billing questions
Straight answers tied to the sections above.
What does dental billing include?
CDT coding, tooth and surface detail, frequency and predetermination checks, images and narratives, medical crossover only when the benefit is medical, submission, posting, denials, and A/R.
How much do dental billing services cost?
The fee is a percentage of net collections. No setup fee on the monthly cycle. The written rate follows procedure mix and crossover volume.
Do dental claims use CPT codes?
The dental benefit uses CDT on the ADA claim or 837D. CPT is for a medical claim when that benefit applies. Do not send both for the same service.
When does a medical plan pay a dental procedure?
When the service meets a medical benefit, such as trauma, infection, fracture, or qualifying hospital oral surgery. A routine filling does not. Follow whether that plan wants CDT or CPT, on one form.
Do we have to change our practice software?
No. Billers work in the system you already use — see EHR integration. Compatibility is confirmed before you commit.
Where does Vector provide dental billing?
The office is 15717 85th St, Jamaica, NY 11414-2620. Work is remote for dental practices in all 50 states. See the specialties hub.
Is Vector Medical Billing HIPAA certified?
HHS does not certify billing companies. Vector signs a BAA, limits PHI to staff on the account, and follows HIPAA workflows. A HIPAA security risk analysis is a separate engagement when scoped.