Skip to content Credex Healthcare offers dental billing services for solo dentists, group practices, DSOs, and specialty clinics facing slow reimbursements, high denial rates, and front desks that spend more time on the phone with insurers than on patients. CDT codes, pre-authorization requirements, frequency limitations, and PPO-specific fee schedule adjustments must all be correct on every claim before it goes out. Our dental billing specialists know those rules across various carriers nationwide.
Credex Healthcare’s dental revenue cycle management handles every step, so your practice gets paid on time, and your team stays focused on patient care.
First-pass claim approval rate
Average dental billing turnaround
PPO, HMO, Medicaid & more
Pre-authorization & benefits verification
Credex Healthcare runs a dedicated dental billing process that checks every claim against the treating dentist’s clinical notes, the patient’s active benefit plan, the payer’s CDT code coverage policies, and any pre-authorization requirement that applies before submission. When dental billing mistakes happen after the claim has been sent in, they cost a lot to fix. We check for incorrect tooth codes, missing X-rays, erroneous surface counts on fillings, and frequency-limits issues before we send the case, not after the EOB comes back incorrect.
Our dental billing services in the USA cover the following:
Claims go out with verified CDT codes, correct tooth numbers and surfaces, attached radiographs where required, and pre-authorization for applicable procedures. Our team tracks adjudication status and follows up before timely filing limits are at risk.
We manage provider enrollment for dentists and hygienists with PPO networks, Medicaid dental programs, and managed care dental plans, cutting the wait between joining a network and billing from the first appointment.
Denied claims are reviewed within 48 hours. Whether the rejection stemmed from a frequency limitation, a missing narrative, a failed downgrade, or an X-ray attachment error, our team corrects it and resubmits the documentation the specific payer requires.
Our dental billing specialists audit procedure notes against CDT codes D0120, D1110, D2740, D7140, and the full ADA code set, confirming surface counts, tooth numbers, and supporting documentation match what was billed.
Pre-authorization of dental procedures is required by most carriers for crowns, endodontics, implants, and oral surgery. We initiate, track, and document authorizations before treatment is scheduled, so no major procedure is billed without payer approval on file.
End-to-end RCM covers benefits verification, charge entry, PPO write-off calculation, payment posting, patient balance management, and monthly reporting, so practice owners have an accurate picture of collections at every stage.
As a dedicated dental billing company in the USA, Credex Healthcare keeps up with changes to PPO fee schedules by carrier, changes to Medicaid dental coverage by state, and the most recent pre-authorization rules for major corrective and surgery treatments from all active payers. Delta Dental, Cigna, MetLife, Aetna, and United Concordia all have very different PPO drop rules. Most generalist billers don’t follow this rule, so they apply a crown code to a three-surface amalgam because the plan lowers the fee for all-ceramic restorations. As a result, dental offices get less money back.
We manage dental insurance billing across major PPO carriers, including Delta Dental, Cigna, MetLife, Aetna Dental, United Concordia, Guardian, and Humana Dental, applying the correct fee schedule, downgrade rules, and frequency limitations for each plan.
Medicaid dental coverage rules and covered CDT codes differ by state. Some states require prior authorization for restorations, extractions, and prosthetics. Our team manages Medicaid dental billing with state-specific code sets and built-in prior-approval workflows.
Orthodontics, oral surgery, endodontics, periodontics, and pediatric dentistry each carry their own CDT code sets, documentation standards, and insurance rules. Our dental billing specialists work across all dental specialties.
For dental service organizations and group practices operating multiple locations, we coordinate provider credentialing, location-level NPI billing, and payer enrollments across all sites under a single managed workflow with consolidated financial reporting.
Dental claims fail for specific, preventable reasons: incorrect tooth surfaces, missing radiographs, expired or absent pre-authorizations, and CDT codes that do not match the chart. Credex Healthcare reviews all of that before submission, so the claim proceeds without issue.
Every dentist and hygienist billing under your practice is verified for active state licensure, valid NPI, correct provider taxonomy, and current enrollment status with each payer before claims are sent under their credentials.
We audit clinical notes against CDT codes across the full ADA code set, including D0120 (periodic oral evaluations), D1110 (adult prophylaxis), D2740 (porcelain crown), and D7140 (standard extraction), confirming that tooth codes, surfaces, and supporting documentation match the procedure billed.
Pre-Authorization Tracking
Authorization status is tracked for every major restorative and surgical procedure before treatment is performed. Approval numbers are documented and attached to claims at submission. Expired authorizations are renewed before the patient is rescheduled.
Dental Documentation Requirements
Payers require specific attachments for different procedure types: periapical X-rays for extractions and root canals, bitewing radiographs for restorations, periodontal charting for scaling and root planning, and clinical narratives for crown submissions. We track each payer's requirements and attach them before submission.
PPO Downgrade & Fee Schedule Rules
PPO downgrade rules reduce reimbursement when an all-ceramic restoration is submitted to a plan that covers only amalgam or three-surface composite restorations. We identify the downgrade in advance, calculate the correct write-off, and post payments at the contracted rate.
Accounts Receivable Follow-Up
Dental AR is reviewed weekly. Unpaid claims are pursued before the timely filing limits close. Underpayments are checked against the PPO fee schedule or Medicaid rate, and short payments are disputed with the supporting clinical documentation.
Dental practices lose revenue in ways that are easy to overlook month to month. Crowns are written off because the pre-authorization expired before the appointment. The scaling and tooth cutting were turned down because the periodontal chart wasn’t included. Medicaid claims for kids were denied due to a lost prior approval that no one kept track of. The dentist’s billing process at Credex Healthcare identifies these problems during the paperwork step, before the chair is set up, not after the payment is returned.
End-to-end dental insurance billing from charge entry and CDT code review to electronic submission with required attachments across PPO plans, Medicaid, and managed care dental programs.
Our dental billing specialists apply the correct CDT codes and modifiers for each procedure type, along with the appropriate attachments, tooth data, and supporting notes, reducing denials due to documentation and billing errors.
Prior Authorization Management
Pre-authorization for dental procedures is tracked from request through approval and attached to the claim before the patient returns for the scheduled treatment. A crown seat cannot be added without authorization already on file.
Denial management for dental claims covers disputes over frequency limitation, X-ray attachment corrections, narrative appeals for medical necessity, and Medicaid prior-approval errors. Each appeal is built around what that specific carrier requires.
Provider enrollment covers new dentist applications, hygienist credentialing where applicable, and ongoing recredentialing, so billing never stalls because a provider's network status lapsed at renewal.
Monthly reports show collections by provider and payer, denial trends by reason code, PPO write-off totals versus expected, AR aging, and dental billing turnaround time, giving practice owners real numbers to manage the business.
Years of Dental Billing Expertise
Provider Enrollment & Credentialing Success
Claim Compliance Rate Across All Payers
Support Available for All Your Needs
Customized Dental Revenue Cycle Solutions
DDS
Anita
“Crown denials were paralyzing our practice. About one in four came back with a frequency-limitation rejection or a missing narrative, and the front desk did not have time to chase every one of them. Credex took over the bills. The first thing they did was fix the way the attachments work. In just six weeks, more than 90% of the crowns were approved. Before I saw what changed, I didn’t know how much money we were throwing away.”
Practice Administrator
Marcus
“Dental billing for kids on Medicaid is a whole other world. It uses a different set of codes, needs to be approved before it can be used, and has strict standards for paperwork. Before we hired Credex, our billing business handled it like any other PPO bills, and we were constantly behind in paying Medicaid claims. Credex knew the rules for each state from the start, and the Medicaid AR was paid off in the first quarter.”
DMD
Rosa
“Periodic billing is hard because the paperwork needed for SRP and osseous treatment varies by payer and changes too quickly for most billers to keep up. Credex updates its payment tips regularly. When claims are sent out, they have the right periodontal charts, the right story, and the right CDT code for what I did. That number dropped from 18% to about 4% in four months.”
CFO
Derek
“Before Credex, it was a pain to keep track of dental bills for 23 doctors on 7 sites. It was impossible for us to see which sites were doing well and which were losing AR. Credex put everything into a system and made sure that all sites followed the same credentialing process. Now I get a monthly report that shows collections, rejections, and write-offs broken down by location. Just having that much access changed how we run the group.”
DDS
Obi
“Most dental billing companies aren’t set up to handle oral surgery claims because they involve pre-approvals, medical cross-billing, and paperwork that is special to each payer. Credex has people who know both the ICD-10 medical diagnosis side of billing for oral surgery and the dental CDT codes. In the first two months, my clearance rate for implant and surgery cases went up a lot, and pre-auth denials pretty much stopped.”
Practice Assessment
We check your present dental billing process, including how long accounts are past due by payer, the history of denials by reason code, the accuracy of your fee schedule, and how you track pre-authorizations. This makes it easy to see where groups are lacking and what needs to be fixed first.
Credentialing & Payer Enrollment
Every dentist and hygienist is verified for active enrollment with each PPO network and Medicaid program in your payer mix. Any gaps in provider credentialing are resolved before new claims are submitted.
Pre-Authorization Setup
We identify every procedure type in your practice that requires payer pre-authorization, establish a tracking process for open authorizations, and flag pending treatment that requires approval before the patient's next appointment.
Clean Claim Submission
Our dental billing specialists review clinical notes and charge entry, verify CDT codes and tooth data, attach required radiographs and narratives, and submit claims electronically to all PPO carriers, Medicaid, and managed care dental programs.
Denial Management & Follow-Up
Every claim is tracked through adjudication. Denials are reviewed within 48 hours. Frequency limitation disputes, missing attachment corrections, and PPO downgrade appeals are each handled with a targeted response rather than a generic resubmission.
Reporting & Ongoing Optimization
Monthly reports cover collections by provider and location, denial trends by payer and reason, PPO write-off tracking, AR aging, and dental billing turnaround time. Recurring errors are corrected at the documentation level, so the same problem does not show up in the next cycle.
Dental billing is not the same as medical billing, but it is easier. On the dental billing side, there are different CDT codes, paperwork needs, PPO drop rules, tracking frequency limits, and pre-authorization processes than on the medical billing side. Practices that use general billing companies for dental claims must deal with repeated rejections and lower payments to cover the shortfall. Dental revenue cycle management is what Credex Healthcare does, as it requires billing experts who work with dental claims every day.
Dentist claims are what we do. We know how the PPO downgrade rules work for Delta Dental, MetLife, and Cigna. We also know how Medicaid dental prior authorization works by state, how radiograph connection requirements vary by treatment and carrier, and where dental billing errors most often occur. Dental billing has not changed from how things are done in a hospital setting.
There is one dentistry billing expert who works only for your practice. This person knows all your treatment mixes, payer contracts, pre-authorization records, and CDT code trends. Someone who already knows the situation handles billing issues.
Owners of dental practices can see monthly reports that show the real state of their finances. These reports show collections by provider and payment, rejection reasons, PPO write-off totals versus the fee schedule, AR aging, and dental billing response time.
Full HIPAA compliance procedures protect all patient data, X-rays, and treatment paperwork that is handled during the payment process. Every system your practice uses for billing follows strict security rules and tracks who can access it.
Dental practices lose revenue in predictable monthly patterns. Crown claims get denied because the pre-auth expired. SRP claims were rejected because the periodontal chart was not attached. Medicaid claims are sitting unpaid because the prior approval number was missing. These are not one-off billing mistakes. They are workflow gaps that an audit identifies in the first few weeks, and that a structured billing process eliminates going forward.
As a first step, Credex Healthcare will do a free audit of your present dental billing. This will include checking your accounts receivable, rejection history by reason code, CDT code correctness, pre-authorization tracking, and customer enrollment status. You do not have to make a promise to get that rating. We determine how much can be recouped and the process changes needed to prevent this from happening again next month.
The process of sending bills for dental work to PPO plans, Medicaid dental programs, and managed care dental insurance is called dental billing. Every treatment is assigned a CDT code from the ADA dental code set, linked to the patient’s current benefit plan, and submitted with the necessary attachments, such as X-rays, periodontal charts, or clinical reports.
Dental billing uses CDT codes, which are made public by the American Dental Association every year. The following codes are often billed: D0120 for periodic oral evaluation, D0150 for comprehensive oral evaluation, D0274 for bitewing X-rays, D1110 for adult prophylaxis, and D1120 for child prophylaxis; D2140 for one-surface amalgam restoration, D2740 for porcelain crown, D3310 for anterior root canal, and D4341 for scaling and root planning, per quadrant; and D7140 for simple tooth extraction and D7210 for surgical extraction. When implants are used, numbers in the D6000 group are used.
Coverage varies based on the patient’s plan type and the kind of treatment. Most PPO dental plans cover 100% of preventive care, such as cleaning and oral evaluations. They also pay 70% to 80% of the cost of basic restorations and only 50% for major procedures like crowns and bridges. Different states have entirely unique Medicaid dental plans for adults. Some states only cover emergency extractions, while others cover a wider range of restorative services.
It takes most PPO dental plans 15 to 30 days to handle clean computer claims. Medicaid dental plans usually pay within 30 to 45 days, but this can change from state to state. These problems are found by Credex Healthcare’s pre-submission review before the claim is sent out. This keeps most dental claims on the faster end of the dental billing turnaround time and reduces back-and-forth with carriers that slow payment.
The billing industry is rapidly evolving. By the year 2025, the system and tools used
Billing companies ensure compliance with HIPAA and other regulations by being legitimate and reliable. Every
At Credex Healthcare, we know how frustrating it is when claims are denied. That is
Fill the form and someone from our team will get back to you. Or you can also call us on (833) 477-1261.
