Dental Billing Codes: A Comprehensive Guide

Managing accurate billing (the backbone of overall practice) in dentistry could be straightforward if it didn't involve constant updates and guidelines. One example of such changes is the Centers for Medicare and Medicaid Services (CMS) introduction of a new billing code for a dental surgical procedure in outpatient hospitals, influencing reimbursement rates for these services from $200 to $2,000, whereas there are other guidelines. To yield efficiently from their efforts to retain quality patient care and reimbursement from dental insurance providers, it is utmost for dentists to understand the many dental billing codes for dental codes services and categories and their purpose to document patient records effectively and accurately for the services rendered as it is the essential step of billing and revenue cycle in an organized dental practice management. In this guide, we offer complete information on the dental codes and their significance in managing dental billing and reimbursement from insurance providers. Stay with us to get efficient financing and payment collection for your dentistry practice by assigning the most fitting and accurate dental insurance billing codes to continue delivering quality dental care to your patients. However, let's review a stepwise dental billing process and its significance first.

Dental Billing - The Financial Foundation In The Dentistry

Dental insurance billing or financial foundation in dentistry is submitting and collecting payment from insurance providers and patients for the services offered. Considering the growing tendency of dental care, dentists need to manage the business side of practice effectively by ensuring that each step of the process, from claim creation and submission, is accurate and patient details are complete. Moreover, precise billing ensures that the care providers are paid for the services offered - to maintain the practice, stability, and profitability on the one hand and improve patient and insurance company trust on the other hand. Furthermore, accuracy in dental billing will save you form the risk of insurance companies investigating claims and billing and financial penalties.
The standard process of dental billing involves the following:
Information gathering from patients - Collecting and recording patient information such as insurance coverage, biography, and medical history.
Treatment planning - The dentist examines the patient's oral health, identifies the problem, and recommends a treatment.
Insurance verification: The dental office ensures that the patient's plan includes coverage and the plan's benefits and limitations.
Submitting claims—The Dental practice submits a claim to the insurance company, including detailed patient data such as patient demographics, treatment codes, and insurance information, to claim payment for the services offered.
Payment collection: Insurance payers analyze the claim and pay the payment according to the patient's insurance coverage, either in total or a portion of the claim's payment.
Account Follow-Up —If the insurance provider doesn't offer reimbursement or complete payment, the dental practice strives to correct the errors causing delays or dental insurance payment denials and maintain communication with insurance providers to resolve the issue.

Dental Procedure Codes LookUp: The Purpose And Function

Dental procedure codes or codes used for billing in dentistry serve as the universal language to communicate the specifics of every dental procedure effectively and for the accurate record-keeping of the services delivered per state laws. These codes in dentistry have a dual purpose: to facilitate smooth communication between dental professionals and insurance payers and to ensure proper reimbursement for dental care providers.
Mainly, the dental coding system is categorized into three categories, each representing a specific significance:

CDT (Current Dental Terminology) Codes:

CDT codes are standardized code sets maintained by the American Dental Association (ADA). To ensure consistency and uniformity in documenting dental treatments in the industry, CDT codes are widely used by dental professionals in the US. The codes describe specific dental treatments and procedures for documentation and insurance claims. CDT codes are alphanumeric, followed, each followed by four numbers (the nomenclature).

The Significance:

• Dentists use CDT codes to report dental procedures on the ADA Claim forms.
• CDT codes help dentists describe procedures in a standardized way and bill insurance providers and patients easily by using a specific CDT code for a particular dental procedure.
• Assigning these codes ensures uniformity in treatment descriptions, as the same code will be used for the same treatment in every dental practice across the US.
• Documentation and record-keeping of all the dental services provided are more accessible for dentists or dental practices.
• Using standardized CDT codes makes data aggregation easier on a broader level, such as in public health research.
• Clear communication—These codes help dental professionals, specialists, insurance companies, and other stakeholders maintain clearer communication.
• Regulatory compliance—Dental professionals use these codes to ensure the regulatory compliance requirements of some state, federal, or insurance programs.

CDT Codes are categorized as per the type of service:

Services	Codes	Categories
Diagnostic	D0100 - D0999	(D0)
Preventive	D1000 - D1999	(D1)
Restorative	D2000 - D2999	(D2)
Endodontics	D3000 - D3999	(D3)
Periodontics	D4000 - D4999	(D4)
Removable Prosthodontics	D5000 - D5899	(D5)
Maxillofacial Prosthetics	D5900 - D5999	(D5)
Implant services	D6000 - D6199	(D6)
Fixed Prosthodontics	D6200 - D6999	(D62)
Oral and Maxillofacial Surgery	D7000 - D7999	(D7)
Orthodontics	D8000 - D8999	(D8)
Adjunctive General Services	D9000 - D9999	(D9)

Evaluation of CDT Codes to report the first, subsequent, or other patient encounter:

Codes	Conditions
D0120	Periodic oral evaluation
D0140	Limited oral evaluation - problem-focused
D0145	Oral evaluation for a patient under three years of age and counseling with the primary caregiver
D0150	Comprehensive oral evaluation - new or established patient
D0160	Detailed and extensive oral evaluation - problem-oriented by report
D0170	Re-evaluation - limited, problem-oriented (established patient, not postoperative visit),
D0171	Re-evaluation - postoperative office visit
D0180	Comprehensive periodontal evaluation - new or established patient
D0190	Screening of a patient
D0191	Assessment of a patient
D9310	Consultation - diagnostic service offered by dentists or physicians other than requesting a dentist or physician
D9450	Case presentation, detailed and extensive treatment planning

Mouth X-ray CDT Codes:

D0210	Intraoral - complete series of radiographic images
D0220	Intraoral - periapical first radiographic image
D0230	Intraoral - periapical each additional film
D0251	Extraoral - posterior dental radiographic image
D0272	Bitewings - two radiographic images
D0274	Bitewings - four radiographic images

HCPCS (Healthcare Common Procedure Coding System) Codes:

• It is a standardized coding system for medical providers to submit claims to Medicare or other health insurance.
• Used similarly to CDT codes but on a broader level, encompassing the services that may not be dental-specific.
• The system includes two medical code sets, HCPCS Level I and HCPCS Level II.
• HCPCS Level I encompasses the current procedural terminology code set and helps in medical claim submission for services performed by physicians and non-physicians, laboratories, hospitals, practitioners, and outpatient facilities.
• HCPCS Level II refers to the national procedure code set for providers, healthcare practitioners, and medical equipment suppliers when filing health claims for medical devices, medications, supplies, transportation services, and other services.
• Dental codes or D codes are a specific type in the National HCPCS Level II Codes for dental procedures and equipment.
• The American Dental Association (ADA) publishes the Current Dental Terminology (CDT) Code set encompassing HCPCS dental services codes.
• The ADA holds the right to CDT codes and any changes, including adding, deleting, and revising dental service codes.

The Significance:

• In the context of dental billing, HCPCS covers unique situations, such as dental services and medical procedures.
• Examples include when a patient with a specific medical condition needs dental care.
• The use of these codes exactly represents the service and its connection.
• Mainly, HCPCS Level II codes indicate the equipment used by the provider in treating and assessing the diagnosis.

ICD Codes In Dental Medical Billing Services

The International Classification of Diseases (ICD) is a medical classification system used widely for health management, clinical purposes, and epidemiology. Its diagnostic codes identify diseases, disorders, and symptoms. Healthcare providers use these diagnosis codes to transform verbal descriptions of diseases, injuries, and illnesses into standardized codes in claims for services.
However, dentists use these codes to convert a patient's oral health into standardized language. Dental offices use these codes to keep the patient's medical record beyond dental problems. In dental billing, ICD codes specify the need for specific dental treatment.

The significance:

• Help insurance providers to understand why a particular procedure was performed.
• Insurance providers understand the reason for dental care provided to determine appropriate patient coverage.
• ICD codes bring dentists and medical professionals together to resolve the issues broadly.
• Doctors and dentists can communicate to work on the best possible solutions for patient care.

Some of the ICD-10 diagnosis dental codes:

A69.0	Necrotizing ulcerative stomatitis
A69.1	Other Vincent's infections
B00.2	Herpesviral gingivostomatitis and pharyngotonsillitis
B00.9	Herpesviral infection: Unspecified
K00.0	Anodontia
K00.1	Supernumerary teeth
K00.2	Abnormalities of size and form of teeth
K00.3	Mottled teeth
K00.4	Disturbances of tooth formation
K00.5	Hereditary disturbances in tooth structure not elsewhere classified
K00.6	Disturbances in tooth eruption
K00.7	Teething syndrome
K01.0	Embedded teeth
K01.1	Impacted teeth
K02.3	Arrested dental caries
K02.5	Dental caries on pit and fissure surface
K02.7	Dental root caries
K03.0	Excessive attrition of teeth
K03.1	Abrasion of teeth
K03.2	Erosion of teeth
K05.0	Acute gingivitis
K05.1	Chronic gingivitis
K05.2	Aggressive periodontitis
K08.1	Complete teeth loss
K08.2	Atrophy of edentulous alveolar ridge
K08.20	Unspecified atrophy of edentulous alveolar ridge
K08.21	Minimal atrophy of the mandible
K08.22	Moderate atrophy of the mandible
K08.23	Severe atrophy of the mandible
K08.24	Minimal atrophy of the maxilla
K08.25	Moderate atrophy of the maxilla
K08.26	Severe atrophy of the maxilla

ICD-10-CM Code(s)

Z01.20	Encounter for dental examination and cleaning without abnormal results
Z01.21	Encounter for dental examination and cleaning with abnormal
Z13.84	Encounter screening for dental disorders

CPT Codes To Report Medical Procedures in Dentistry

Dentists use several CPT codes to indicate medical services that are not involved in routine dental care and are counted as medical in nature. Commonly, dentists use CPT Codes in practice, which are called Category I Codes and are categorized into six ranges:

• Evaluation and Management - 99201-99499
• Anesthesia - 00100-o1999; 99199-99150
• Surgery - 10000-69990
• Radiology - 70000-79999
• Pathology and laboratory - 80000-89398
• Medicine - 90281-99099; 99151-99199; 99500-99607

Some of the other conditions in which dentists can use CPT codes in dentistry are:

Oral and maxillofacial surgery

Example CPT codes:

D7210	Extraction, erupted tooth or exposed root (elevation or forceps removal)
D7140	Extraction, erupted tooth or exposed root (elevation or forceps removal), and closure.
D7210	Surgical removal of an erupted tooth requires elevation of a mucoperiosteal flap and removal of bone or tooth section.

Sleep apnea treatment

21080	- Genioglossus advancement (e.g., genioglossus muscle flap).
21110	Genioplasty; augmentation (e.g., alloplastic material).
21120	Genioplasty; sliding osteotomy, single piece (e.g., horizontal or V-Y advancement).
21141	Mandibular osteotomy for distraction osteogenesis, other than ramus, unilateral.

Treatment of temporomandibular joint (TMJ) disorder

21050	Arthrotomy, temporomandibular joint
21051	Arthrotomy, temporomandibular joint, with disc repositioning.
29805	Arthroscopy, temporomandibular joint, diagnostic, with or without synovial biopsy (separate procedure).

Diagnosis and treatment of oral lesions

40808	Excision of malignant lesion of lip (vermilion) with bilateral reconstruction
41000	Excision of lesion of the tongue with closure.
41115	Excision of lesion of the jaw.

Tumors or other pathology

21031	Excision of the tumor, the soft tissue of the face or neck, except skin, less than 1.5 cm.
21044	Excision of the tumor, mandible, except benign odontogenic tumor, composite resection.
21076	Excision of tumor, palate, or uvula area, excised diameter over 4.0 cm.

Management and treatment of facial trauma

21480	Open treatment of orbital fracture.
21485	Open treatment of complex midfacial fracture (LeFort type II or type III).
21610	Closed treatment of mandibular or maxillary alveolar ridge fracture.

In case dental and medical conditions overlap, dentists collaborate with medical providers to bill these situations accurately.

Common Dental Procedures And Their Corresponding Codes

Understanding the categorization of different dental procedures in dental coding will create a roadmap for you to deliver complete patient care. Here is a breakdown of common dental procedures and codes associated with these conditions to help efficiently bill for the services:

Preventive Procedures

Codes	Procedures
Routine check-ups (D0120) Cleanings (D1110) Fluoride treatments (D1206)	Intent to prevent dental issues before they occur. Codes strongly emphasize routine examinations, cleanings, and preventive care.

Diagnostic Procedures

Codes:	Procedures
X-rays (D0210 - D0330) Comprehensive oral evaluation (D0150 - D0180) Impressions (D0470)	Focuses on recognizing and classifying dental disorders. Codes include diagnostic impressions, X-rays, and thorough assessments.

Restorative Procedures

Fillings (D2391 - D2940) Crowns (D2740 - D2750) Bridges (D6240 - D6792)

Center on repairing and fixing broken teeth Dental treatments covered by codes include crowns, bridges, and fillings

Surgical Procedures

Extractions (D7999) Implant procedures (D6010 - D61099) Periodontal surgeries (D4210 - D4999)

Includes many surgical procedures and extractions. Codes describe complex operations like periodontal and implant surgery.

Example Scenarios When Codes Can Work Together - The Billing Efficiency

Successful dental billing requires dentists to work on different types of coding systems in collaboration to yield effective and accurate results for communication and documentation. Some of the examples of overlapping dental and medical conditions include:

• Dentists use HCPCS Codes to represent special cases, such as when a patient with a certain medical condition needs dental care. These codes accurately indicate the services for reimbursement.
• Dental insurance providers accept the claim form that correctly uses ICD, CPT, and HCPCS and efficiently indicates detailed patient information, information on associated diagnoses, and medical necessity.
• ICD-10 Codes codes also play an essential role in standardizing procedures and diagnoses related to dental care.
• ICD-10 codes in claim documents for dental benefits inform the payer about the medical necessity or reason for why a certain procedure is performed.
• These code categories K00 to K95 describe digestive system issues, including mouth diseases and conditions treated by dentists.
• Moreover, the codes help care providers describe conditions beyond dental treatment when a patient has a specific health condition.
• In specific cases, CPT codes are also used in dental practices, such as reporting medical conditions.
• ICD and CDT codes can be used together in claims intended to be submitted to dental benefit plans.

Dental Billing Codes 2024 - CMS New Guidelines

• CMS included new billing codes for dental surgical procedures in outpatient hospitals in 2024.
• More than 25 new dental billing codes have been added for dental surgical procedures in ASCs, part of the 2024 OPPS and ASC's financial rule.
• These codes help dentists to offer additional oral health services in dentistry practices.
• CMS is finalizing Medicare payment rates under the OPPS for more than 240 dental codes.
• These codes are in line with the dental payment provisions in the recent 2023 Physician Fee Schedule final rule with their assignment to clinical ambulatory payment classifications (APCs).
• CMS believes that assigning these additional codes to clinical APSs increases the consistency of Medicare payments in different service sites.
• CMS also addresses patient's additional issues related to dental services under anesthesia in an ASC setting.
• CMS also finalized the addition of 26 separately payable dental surgical procedures to the ASC Covered Procedures List (CPL).
• They also add 78 ancillary dental services to the list of ancillary dental services.

The Best Practices For Assigning Dental Billing Codes

• Proper knowledge and education on these coding systems, including ICD, CDT, HCPCS, and CPT, are essential for dentists to bill accurately for service reimbursement and offer efficient patient care.
• Accurate code assignment and thorough clinical documentation for claiming timely reimbursement and avoiding the risk of potential fraud, violations, and accusations of state and federal laws, including non-compliance programs.
• Understanding and maintaining each insurance payer's requirements varies from the other.
• Researching the current challenges, including the appeals procedures, comprehending explanation of benefits (EOBs), claiming medical carrier credentialing, and understanding dental insurance verification.
• Keeping dental practice up-to-date with the newest coding and billing guidelines and proficiency at managing dental claim denials.
• Leveraging dental billing software and services to ease billing operations and save time for more critical tasks in dentistry.
• Ensure compliance with regulations in dental claim filing and claim submission process.
• Understanding the differences between different coding categories and utilizing them effectively to ensure accuracy.

Putting Your Efforts In The Right Place With The Most Latest And Accurate Dental Billing Codes

MedsDental Billing Company constantly strives to maintain the efficiency and revenue of dentists' practices. We care for your dental billing while you are busy offering the best possible care to your patients. Connect with us to get the most accurate results in claim management and code assignment to get complete reimbursement for dental services from dental insurance carriers. We help your practices stay compliant and secure from potential risks with our experience and continuous knowledge of coding updates and assigning accurate dental billing codes.