Understanding Medical Billing for Dentists and Its Benefits

There is much more to dental practices than cavity treatment and cosmetic makeovers of smiles. Dentists nowadays frequently carry out procedures that are viewed by insurance as medical and not necessarily dental, like TMJ procedures, oral surgeries, sleep apnea appliances, accident-related trauma treatment, and oral cancer biopsies. However, most offices miss thousands of dollars in claims each month because they submit claims only to dental plans. This is where medical billing in dentistry comes in and makes all the difference. This will allow the dentists to access the advantages of medical billing in dentistry that translate to direct, immediate benefits in the form of increased revenue, better patient care, and additional referral sources.

What is Medical Billing for Dentists?

Medical billing for dentists refers to the process of filing claims to the medical insurance of a patient (not dental insurance) for the medically necessary procedures. Whereas routine checkups and fillings are usually included in the services of dental plans (Delta Dental or Cigna Dental), medical carriers (UnitedHealthcare, Aetna, Blue Cross Blue Shield, and even Medicare) often include services associated with accidents, birth defects, infections, sleep disorders, and oral pathology.

As an example, placement of a mandibular advancement device by a dentist due to the presence of obstructive sleep apnea or a frenectomy in an infant with a breastfeeding problem is a service subject to medical insurance charges with CPT and ICD-10 codes, not ADA dental codes. Thus, you can bill for it, which is an advantage of medical billing in dentistry

Why Do So Many Dental Practices Ignore Medical Billing?

Most dentists think medical billing is too complex, time-consuming. As a matter of fact, lack of training is the greatest cause. CPT coding, HIPAA medical claims policies, and writing a narrative that has a bone graft of $4,500 approved are things not taught in dental schools. This leads offices to refuse to carry out medically necessary procedures altogether or offer them free of charge. They are unaware of the many advantages of medical billing in dentistry.

What Are the Advantages of Medical Billing in Dentistry?

1. Rapid Growth in Cases Being Accepted

Patients often refuse to pay too much to treat their dental problems since their dental plan has little or no coverage. Patients agree much more frequently when the same procedure is billed with the medical insurance.

A 2025 report revealed that 80 percent of medical bills contain errors. For example, the acceptance of sleep apnea cases when the practices bill through dental insurance to have their oral appliances is a cause of error.

2. Increased Reimbursements of Major Procedures

Medical plans usually charge more than the dental plans when the same service is rendered. Here are some procedures:

Procedure

• Surgical Extraction (impacted wisdom teeth)
• Bone grafting
• TMJ Arthrocentesis
• Oral sleep apnea appliance

3. Access to Patients Without Dental Benefits

Approximately 72 million Americans are uninsured in terms of dental services; however, virtually all people have medical insurance. With medical billing, you can treat uninsured patients and earn a decent amount at the same time.

4. Stronger Referral Relationships with Physicians

Once you manage to cure the sleep apnea, the migraines, or the trauma of a patient through his or her medical benefits, you turn out to be the specialist. Doctors are fond of sending patients to dentists who could ease their lives and minimize liability on their part.

5. Medicare Opportunities for Selected Services

Medicare currently includes medical necessities, oral surgery, some sleep-apnea treatment, and head/neck radiation-related procedures. Credentialed dentists can serve the rapidly increasing patient base in America under Medicare.

How Medical Billing Works in a Dental Office?

Step 1: Check dental and medical benefits during the new-patient intake.
Step 2: Report medical necessity using adequate ICD-10 codes, clinical notes, and photos.
Step 3: Use correct CPT and HCPCS codes (not CDT dental codes)
Step 4: Submit the claims electronically using a medical clearinghouse.
Step 5: Follow up on unpaid or rejected claims by appeals where necessary.

Numerous practices outsource the task of credentialing, coding, submitting, and appealing to more qualified medical billing firms, such as Capline Healthcare Management, to allow the dental team to concentrate on patient care.

What Procedures are Frequently Included Under Medical Insurance?

The following is a table of high-impact services that may be quickly looked up:

Category	Common Procedures Billable to Medical Plans
Trauma & Accidents	Fractures, lacerations, avulsed teeth, and emergency exams
Oral Surgery	Wisdom teeth, tori removal, apicoectomy, biopsies, bone grafts
Sleep Apnea	Custom oral appliances, follow-up titrations
TMJ/TMD	Splints, arthrocentesis, trigger-point injections
Congenital Defects	Cleft lip/palate repairs, frenectomies (infants & ankyloglossia)
Infection & Pathology	Incision & drainage, oral antral fistula closure, cancer screenings

Frequently Asked Questions Concerning the Advantages of Medical Billing in Dentistry

Q: Do I have to become a medical provider to bill medical insurance?

A: Yes. All dentists and hygienists who provide medical services are required to enroll with each carrier (credentialing). It may require 90-120 days, and some companies, such as Capline Healthcare Management, will do it on your behalf.

Q: Will medical billing confuse my front desk or slow down my schedule?

A: Not if done correctly. Most successful offices will introduce one talented medical biller or outsource the whole process. The flow of patients does really increase as the number of cancellations decreases due to cost concerns.

Q: What if a claim gets denied?

A: During the initial few months, there is a high rate of denials, but this drops drastically after the office has been informed of the right way of doing things. Efficient billing services start giving advantages of medical billing in dentistry because you have higher clean claims, and all appeals are done at no additional cost.

Q: Can medical insurance be billed for dental procedures?

A: Yes, it is 100% legal and ethical. When the procedure is done according to the medical necessity rules, and the documentation is made. Most state boards and the American Dental Association promote the use of cross-coding when it is proper.

Conclusion

Advantages of medical billing in dentistry can no longer be considered an option. They are table stakes for practice, interested in success in 2025 and thereafter. Treat a single sleep apnea patient monthly or do complicated reconstructive surgeries every single week; adding medical billing functionality will change your bottom line and access to care by patients.

Do not leave money on the table due to old myths or untrained individuals. Call a reliable medical billing firm today and begin to claim all the money that your practice deserves.

Willing to find out the amount of untapped revenue that is lurking in your patient charts? Book a revenue analysis with Capline Healthcare Management, and find out just how much of your revenue can be added by medical billing this year. Call 469-209-5370 or visit the website, www.caplinedentalservices.com!