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EOB posting means entering the insurance payment and insurance decision into the patient's account correctly.
Commonly associated with Keystone First dental claims in our workflow.
May appear as UnitedHealthcare Community Plan or UHC dental.
Commonly seen in connection with Health Partners / health-plan dental administration.
May appear as GHP Family / Geisinger Medicaid. Always identify the actual payer shown on the EOB.
Before posting Medicaid EOBs, become familiar with the Smile Center locations. The office name matters when researching claims, contacting managers, checking providers, and reporting posting problems.
Know which providers and plans are associated with this office.
Know which providers and plans are associated with this office.
Know which providers and plans are associated with this office.
Know which providers and plans are associated with this office.
Know which providers and plans are associated with this office.
Familiarize yourself with the office locations and scheduling information:
Think: COVERED or NOT COVERED — not “50% coverage.”
Office charge = $200. Medicaid allowed amount = $70. Medicaid pays $70. EOB shows $0 patient responsibility.
Patient balance: $0 unless the EOB and plan rules specifically say otherwise.
For Pennsylvania Medicaid posting, treat Medicaid as the payer of last resort. If the patient has another liable insurance plan, that plan is billed first and Medicaid is secondary.
Example: patient has a PPO plan and Medicaid. Bill the PPO first. Medicaid is secondary.
If the patient has two Medicaid insurance plans and you are posting the payment from the primary Medicaid plan, make sure the secondary plan is not forgotten.
Create an Open Dental task for the biller to bill the secondary Medicaid insurance.
The task is used to track that the secondary claim still needs to be submitted.
“Abington office. Patient #1310. Primary Medicaid payment has been posted. Patient also has secondary Medicaid coverage. Please bill the secondary Medicaid plan.”
When you need information, clarification, or action from an office, communicate clearly and follow up until the issue is resolved.
The poster will be added to Google Chat groups for each office.
Use the correct office group when asking about a patient, claim, authorization, provider issue, or rebilling request.
Use the office phone extensions when the issue is urgent or easier to explain verbally.
Speak with the office manager directly when manager approval or instructions are required.
You may also call the biller or billing manager when the question is related to billing, claim corrections, rebilling, payer issues, or claim follow-up.
Do not assume that sending one message means the issue is finished.
Follow up on your requests until you receive instructions or confirmation that the claim issue has been resolved.
A corresponding Open Dental task must be created for each request that needs follow-up from the biller.
Examples: rebill, correct claim, denial needs more information, resubmit with authorization, eligibility issue, provider issue.
The Open Dental Task List allows us to track your communication with the biller and make sure requests are completed.
A task is NOT a replacement for other communication. It is an additional tracking step.
Example: create a task asking the biller to resubmit the claim, then also call the biller's extension or send a Google Chat message.
Once the work is completed, the biller will mark the task as completed.
Create an Open Dental task whenever the claim needs the biller's follow-up or action.
Create a task when a corrected claim or resubmission is needed.
Create a task when member ID, payer, authorization, provider, code, or another claim detail needs correction.
Create a task when the payer needs documentation, clarification, reconsideration, appeal, or additional follow-up.
Create a task when a major denied procedure is left open for the biller to investigate or rebill.
“Abington office. Patient #1310. D2740 #19 denied because prior authorization was not attached. Approval #123456 is active. Please correct and resubmit the claim with the approval number attached.”
Use the same order every time. The payer may change the layout, but the information you need is usually the same.
Identify the insurance company, EOB/remittance date, payment number, payment cycle, EFT/check information, and page number.
Confirm patient name, member ID, DOB, and subscriber/member information.
Confirm provider name, provider NPI, office/reference number, location, plan, product, and network information.
Find the claim number, encounter number, authorization/preauthorization number when shown, and office reference number.
Read the code, tooth when applicable, description, DOS, and each individual procedure line.
Compare billed/submitted amount, approved/allowed amount, plan payment, write-off/adjustment, patient responsibility, and other insurance.
Look for processing policies, exception codes, service payment notes, denial messages, or other reason codes.
Confirm that the total payment you post matches the remittance/EOB total and that no procedure was accidentally missed.
Sometimes Medicaid takes back money that was paid on an earlier EOB.
Example: original payment = $85. A later EOB shows −$85. This is a reversal / recoupment / takeback of the earlier payment.
Do not treat this like a new $0 denial.
Before finishing an EOB, confirm that the total insurance payment entered in Open Dental exactly matches the total EFT, check, or remittance amount being posted.
The EOB / EFT total is $3,842.17.
After posting all patients and procedure lines, the total insurance payment entered in Open Dental should also equal $3,842.17.
If the totals do not match, stop and investigate before finishing the payment.
Possible reasons include:
The very top identifies DentaQuest and shows remittance information such as Internal ID, Payment Cycle, Payment #, EOB Date, and page number. Use this when locating the payment or discussing the remittance with billing.
The Claim Detail block shows the patient name, member number, member type, DOB, provider name, provider NPI, office reference number, group/sub-group/product, service address, claim number, and authorization field.
Before investigating a denial, confirm that you are looking at the correct patient, office, provider, and plan.
Submitted Code is what the office billed. Paid Code is the code the payer processed. They are often the same, but if they differ, investigate why.
The Tooth column identifies the tooth when applicable. The Description gives the procedure name.
This is the date the procedure was actually performed. Eligibility, frequency limits, and authorization validity must be evaluated for this date.
This is the office charge / billed fee. In the upper claim, the submitted total is $5,404.
These columns show what the payer approved and recognized under the plan. In the upper claim, they show $0, which is a strong signal that the procedures were not approved for payment on this processing.
This is the amount the EOB assigns to the patient. In this example it is $0. Do not create a patient balance simply because Plan Pay is $0.
DentaQuest displays the amount it considers an adjustment/write-off. In the upper claim, the EOB shows large write-offs because the Plan Pay is $0.
This is the amount Medicaid actually paid for the line. $0 Plan Pay means no payment was made for that procedure on this EOB.
Codes such as the processing-policy numbers shown on the right help explain why a line was processed a certain way. When payment is $0, identify the payer's actual reason before deciding what to do.
The bottom patient is a good example of normal payment:
This demonstrates an important rule: Plan % can show 100% even though the insurance payment is much lower than the office charge. “100%” means the payer is paying 100% of its allowed fee—not 100% of the office fee.
Each patient has a separate Claim Detail block. Do not mix procedure lines from one patient with the patient above or below.
Look at Member #, Member Type, DOB, Group, Sub-Group, and Product. The EOB may distinguish Medicaid Adult vs. Medicaid Child products.
Verify provider name/NPI and the service address or office reference. This becomes critical if a claim later denies because a provider is not enrolled or not in network.
Never look at Plan Pay by itself. Read Submitted → Approved/Allowed → Patient Pay → Writeoff → Plan Pay as one sequence.
In the middle claim, D1110 shows approximately:
$201 − $40.81 = $160.19 write-off. The patient is left with $0.
The claim shows a much higher office charge than the payer's allowed amount. That does not mean the X-ray is “partially covered.” It means the payer paid its allowed Medicaid fee and the difference is the contractual adjustment/write-off.
A Plan % of 100% should not be interpreted as “insurance pays 100% of our office fee.” It means the payer is paying according to the covered/allowed amount shown on the EOB.
The total row summarizes the claim. Use it as a final check after posting all individual lines. The sum of the line payments should match the claim total.
The top identifies UnitedHealthcare Community Plan - PA, the payee, and the remittance date. It may also show payment-method terminology such as FFS — Fee For Service.
Look for Patient Name, Subscriber/Member ID, DOB, and Office Reference Number. Even though the layout is different from DentaQuest, you are confirming the same core information.
Confirm Provider Name, Provider NPI, Plan, Product, Encounter #, and Benefit Level. Benefit Level may show whether the claim processed in network.
Each line shows the Date of Service, procedure code, place of service, and quantity.
This is the office charge. It is equivalent to DentaQuest's Submitted amount.
This is the payer's recognized fee. It is the number you compare to Open Dental's expected insurance amount / fee schedule.
When there are no copays, deductibles, other insurance, or other adjustments, the Payable Amount and Net Amount may match the Allowed Amount.
The upper claim shows:
The implied adjustment/write-off is $100.60 because $126 − $25.40 = $100.60.
The EOB can show 100% while paying only the allowed fee. Again, 100% does not mean 100% of the office charge.
These fields explain whether any amount was assigned elsewhere. For the paid examples shown, these values are $0.
If a line is denied or adjusted, exception codes or service-payment notes may contain the reason. A blank/zero note on a normally paid line is not a denial.
Some payer layouts do not show an explicit Writeoff column. You still compare the Billed Amount with the Allowed Amount and verify that Open Dental's write-off/fee schedule matches the payer's actual allowed fee.
A write-off removes an amount from the patient's account so the patient no longer owes it.
Simple meaning: the balance “disappears” from the patient's account.
Also called the office fee or office charge.
This is the amount the office originally charged for the procedure before insurance processes the claim.
Also called the in-network fee, approved amount, covered amount, or sometimes the amount people informally call the “insurance pays” amount.
This is the amount Medicaid recognizes for the procedure according to the plan's fee schedule and rules.
BLE means Benefit Limit Exception.
It is an insurance approval for a procedure that would normally be outside the patient's standard benefit limits because of a qualifying medical exception.
When a BLE is required, it must be approved before the procedure is billed.
Prior authorization means the insurance approved a treatment before billing when that procedure requires approval.
The approval has a prior authorization number. That number may need to be attached to or entered with the procedure / claim.
The amount still showing as owed by the patient after insurance payments and adjustments are posted.
For Medicaid claims, a remaining patient balance is usually a sign that the claim or posting needs to be reviewed.
A write-off makes the unpaid balance “disappear” from the patient's account.
Office charge = $200. Medicaid pays $70. The remaining $130 needs to be handled according to the EOB.
If the correct write-off is $130, posting that write-off makes the patient's remaining balance $0.
If an exam or X-ray remains unpaid, the poster may completely write it off according to office policy.
Contact the office manager and ask for instructions.
“Crown on #19 denied. EOB says prior authorization required. I checked the account and there is no authorization number attached. Please advise whether this should be corrected and rebilled or handled another way.”
The provider or entity whose information is used to submit the claim to insurance for payment.
The billing provider information must match the payer's enrollment and credentialing records.
The dentist or provider who actually performed the procedure.
The treating provider may be different from the billing provider.
NPI = National Provider Identifier.
This is the provider's or organization's unique healthcare identification number used on claims.
Tax ID, EIN, and TIN are terms used for the business tax identification number.
This identifies the business or billing entity for tax and insurance purposes.
The identification number assigned to a provider by Medicaid or a Medicaid plan.
A provider may have different enrollment or identification numbers depending on the Medicaid plan.
The person whose insurance coverage is being billed.
For Medicaid plans, the patient is always the subscriber.
The patient should not be entered as a dependent under a parent, spouse, or another person for Medicaid billing.
The insurance plan that must process the claim first.
If a Pennsylvania Medicaid patient also has another liable insurance plan, that other plan is generally billed before Medicaid.
The insurance plan billed after the primary insurance has processed the claim.
In this training workflow, Pennsylvania Medicaid is treated as the secondary / payer-of-last-resort coverage when another liable plan exists.
COB = Coordination of Benefits.
COB determines which insurance pays first and which insurance is secondary when a patient has more than one plan.
DOS = Date of Service.
This is the exact date the dental procedure was performed.
Eligibility and authorization must be checked for the correct DOS—not only for today's date.
The date after which a prior authorization is no longer valid.
A procedure may have been approved, but if treatment is completed after the authorization expiration date, the claim may deny.
Upper jaw / upper arch.
Example: maxillary denture = upper denture.
Lower jaw / lower arch.
Example: mandibular denture = lower denture.
A full upper or lower row of teeth.
There are two main arches: maxillary and mandibular.
One quarter of the mouth.
The mouth is divided into four quadrants: upper right, upper left, lower right, lower left.
A tooth that is blocked or has not fully erupted into the mouth.
Impacted teeth commonly appear in oral-surgery / extraction claims.
A clinical chart containing gum and periodontal measurements.
Insurance may request it to support periodontal procedures such as SRP.
Each letter represents a surface of the tooth. A filling code may involve one surface or several surfaces.
The more surface letters listed, the “bigger” the filling.
| Letter | Surface Name | Simple Meaning |
|---|---|---|
| M | Mesial | Side toward the middle/front center of the mouth |
| D | Distal | Side away from the middle/front center of the mouth |
| O | Occlusal | Chewing surface of a back tooth |
| I | Incisal | Biting edge of a front tooth |
| B | Buccal | Surface toward the cheek |
| F | Facial | Surface toward the lips / face |
| L | Lingual | Surface toward the tongue |
#21 BOL means tooth #21 has a filling involving the Buccal, Occlusal, and Lingual surfaces.
Three letters = a three-surface filling.
A written explanation sent to insurance describing why a procedure was necessary.
It may support a claim, preauthorization, appeal, or documentation request.
Insurance processed the claim but did not approve payment for a procedure.
The denial reason must be investigated before deciding what to do next.
A request asking insurance to reconsider a denial or payment decision.
An appeal may require X-rays, narratives, clinical records, or other supporting documentation.
A discussion between the treating dentist/provider and an insurance clinical reviewer.
It may be used when clinical clarification is needed for an authorization or denial.
An intraoral dental X-ray that shows the tooth, root, and surrounding bone.
Often used to support root canal, extraction, crown, and other claims.
A regular clinical photograph taken inside the patient's mouth.
It may document decay, a broken tooth, an existing restoration, or another visible condition.
An X-ray taken before the procedure.
It documents the condition before treatment.
An X-ray taken after the procedure.
It documents the result after treatment.
The final radiograph documenting the completed treatment.
For some procedures, insurance may request a final X-ray before payment.
The deadline set by the insurance plan for submitting a claim after the date of service.
If a claim is submitted after that deadline, insurance may deny it for timely filing.
Notify the office manager whenever you see this denial. It means the claim was not submitted to insurance on time and the billing workflow needs to be reviewed.
The process of confirming that the total insurance payment entered in Open Dental matches the total EFT, check, or remittance amount.
Example: if the payment total is $3,842.17, Open Dental must also total $3,842.17 before the payment is finished.
If the totals do not match, something may be missing, duplicated, reversed, or entered incorrectly.
The patient already received the same or similar covered service too recently.
A benefit may be covered for one age group but not another.
The patient's specific plan does not include the procedure as a standard benefit.
The procedure may require approval before it can be paid.
If you see a timely-filing denial: notify the office manager. This means the claim was not submitted to insurance on time and requires management/billing review.
| Procedure | Common Rule to Recognize | Posting Thought |
|---|---|---|
| Routine Cleaning | Usually 1 every 6 months | If denied for frequency, check the EOB reason before moving anything to patient balance. |
| Periodic Exam | Usually 1 every 6 months | Look for frequency-limit denial. |
| Comprehensive Exam | Commonly limited, often around 1 every 3 years | Verify the member's exact benefit. |
| Panoramic X-ray / FMX | Commonly limited, often around 1 every 3 years | Verify frequency on EOB / payer portal. |
| Same Filling / Same Surfaces | Commonly limited, often around 24 months | Example: tooth #21 BOL repeated too soon may deny. |
| Extraction | Generally covered when medically necessary and plan requirements are met | Code and clinical situation matter. |
| Partial Denture | May be limited to once every 5 years or once per lifetime | Prior approval / benefit-limit rules may apply. |
| Complete Denture | May be limited to once every 5 years or once per lifetime | Prior approval / benefit-limit rules may apply. |
Do not assume these procedures will pay just because they were completed.
You start entering the claim and all of the following match:
This is the ideal situation. The goal is to get to this for most claims.
If the EOB and Open Dental expectations match, the patient's insurance plan and fee schedule are most likely set up correctly in Open Dental.
Insurance paid for the procedure, but the write-off on the EOB does not match the write-off expected by Open Dental.
This almost always means one of the following:
If insurance consistently pays higher or lower than Open Dental expects, Open Dental may be using the wrong allowed fee.
This causes incorrect:
We bill D1110 cleaning at $120.
Open Dental shows an expected write-off of $40.
That means Open Dental is expecting insurance to pay:
When we post the actual EOB, insurance pays $85 and the actual write-off is $35.
Insurance's allowed fee for D1110 is $85, but Open Dental is currently expecting only $80.
This means the fee schedule in Open Dental is likely $5 too low for this procedure.
“D1110 billed at $120. Open Dental expected $80 payment and $40 write-off. EOB paid $85 with $35 write-off. It looks like the allowed fee in Open Dental is $5 lower than the payer's current fee. Please check whether the patient's fee schedule or the D1110 fee needs to be updated.”
We split a claim when part of the claim was paid, but another procedure on the same claim was completely denied and we are not instructed to write that denied procedure off.
The goal is to post the paid procedures correctly while leaving the denied procedure open by itself for further review or rebilling.
Split the claim when:
The same claim includes:
“The claim paid for the exam, X-rays, and filling, but D7140 extraction was denied. I split the claim, posted the paid procedures, and left D7140 by itself. The EOB denial says missing documentation. Please advise whether to correct and rebill.”
A $0 payment does not automatically mean the procedure should be written off or charged to the patient.
Insurance pays $0.
EOB says Patient Not Found, invalid member, subscriber not found, or similar wording.
Open the patient's Images section and find the insurance verification screenshot or insurance card image.
Compare the verification screenshot to the Open Dental Family Module.
Example: the insurance verification screenshot shows member ID ABC123456, but Open Dental was entered as ABC123465.
“Abington office. Patient #1310. Claim denied as Patient Not Found. I checked the insurance verification screenshot in Images. The correct Medicaid ID is ABC123456, but Open Dental shows ABC123465. I advise correcting the ID and rebilling the claim.”
Insurance pays $0 and says Patient Not Found.
You check the insurance verification screenshot in Open Dental Images.
The insurance ID, payer, patient name, and DOB all match the Open Dental Family Module.
The patient may not have been eligible on the Date of Service (DOS).
The patient may have been active when the office originally verified insurance, but coverage may have ended before the procedure was completed.
Do not independently close the claim or transfer the balance.
Notify the manager and request approval.
Under office workflow, these claims may ultimately be closed and the patient may accumulate a balance if the patient truly had no active Medicaid coverage on the DOS. Manager approval is required before taking that action.
“Wyncote office. Patient #2450. Claim denied as Patient Not Found. Insurance verification image matches the Open Dental Family Module. I checked the payer portal for the DOS and the patient shows inactive on that date. Please review and approve the next step before the claim is closed or any patient balance is created.”
You see D2740 crown billed, but the EOB shows $0 payment.
Check:
Copy the approval / preauthorization number.
Do not close the claim.
Notify the manager that the approval is expired and advise that the approval be resubmitted / renewed and the claim rebilled after the new approval is obtained.
Advise the manager to rebill the crown with the approval number attached again.
Sometimes Medicaid may deny even when approval exists because the approval number was missed, not linked correctly, or not recognized clearly by the claims system.
Notify the manager that the crown appears to have been billed without prior approval.
Do not write off the crown and do not close the claim without manager instructions.
“Abington office. Patient #1310. D2740 crown on #19 paid $0. I checked Images → Preauthorization and found approval #123456. The approval is still active and not expired. I advise rebilling the crown with approval #123456 attached again.”
“Montgomery office. Patient #2450. D2740 crown paid $0. I found the crown approval in the Preauthorization folder, but the authorization expired before the DOS. I left the claim open. I advise resubmitting the approval and rebilling after a new approval is obtained.”
“Wyncote office. Patient #3821. D2740 crown paid $0. I checked Images → Preauthorization and did not find an approval for this crown. It appears the crown was billed without prior approval. I left the claim open. Please review.”
We bill a covered procedure. Insurance pays $0.
The EOB says: patient not found, invalid member ID, subscriber mismatch, or eligibility problem.
We bill D1110 at $120.
Insurance pays $0.
EOB says the service exceeds the frequency limit.
Patient is 11 years old.
We billed D1110 — adult cleaning at $120.
Insurance pays $0.
We bill D0210 FMX at $70.
Insurance pays $0.
We bill D0210 FMX at $70.
Insurance pays $30.
We bill D0120, D0140, or D0150.
Insurance pays $0.
We bill D2740 crown at $800.
A valid prior authorization number is attached.
Insurance pays $0.
We bill D2740 at $800.
Insurance pays $0.
EOB says prior authorization required.
The patient is over age 20.
Root canal treatment is typically not covered under the patient's standard benefit.
The office submits a prior authorization with:
Insurance determines that the root canal is medically necessary and approves a Benefit Limit Exception.
The office receives an approval / prior authorization number.
The payer may miss the approval number, the approval may not be clearly registered in the claims system, or the claim may not link correctly to the authorization.
“Root canal was approved through BLE and billed with authorization number, but Medicaid denied it. I split the claim and left the root canal unpaid. Please review the denial and advise whether it should be corrected and rebilled.”
We bill D3310, D3320, or D3330.
Insurance pays $0.
We bill D7140 or D7210.
Insurance pays $0.
We bill D5110, D5120, D5211, D5212, D5213, or D5214.
Insurance pays $0.
A claim was sent to the wrong Medicaid dental payer.
Insurance pays $0 or says the patient is not eligible.
The account shows one plan, but the patient's active dental coverage for the date of service is through another payer.
We bill a crown, root canal, extraction, denture, or partial denture.
Insurance pays some money, but a large balance remains.
“Insurance didn't pay. What should I do?”
“Abington office. Patient #1310. D2740 crown on #19 billed at $800. Insurance paid $0. EOB denial says prior authorization missing. I checked the patient's account and found authorization #123456, but it was not attached to the claim. I split the claim and left the crown unpaid. I advise to correct and rebill.”
The claim is submitted correctly, but insurance pays $0.
The EOB says the provider is not in network with this plan or the provider is not eligible to bill this Medicaid plan.
The claim may need to be rebilled under another properly enrolled / credentialed provider when appropriate and permitted.
“Abington office. Patient #1310. Claim paid $0. EOB says the treating/billing provider is not in network with this Medicaid plan. I left the claim as is and did not enter a $0 payment. Possible solution is to rebill under another eligible provider. Please review.”
We bill D9110 — palliative treatment of dental pain, but Medicaid pays $0.
D9110 may be billed with X-rays, but it should not be billed on the same claim with another treatment procedure.
Examples of procedures that may cause D9110 to deny when billed on the same claim include:
Do not look only at D9110. Check every procedure billed on the same claim.
If the EOB or claim review shows that D9110 denied because another non-X-ray procedure was billed on the same claim, write off D9110.
Do not leave a patient balance for D9110 in this situation.
Investigate the denial.
Possible issues may include eligibility, patient information, payer information, provider enrollment, claim submission information, or another denial reason.
The claim contains:
Insurance pays the X-ray and filling but denies D9110 because another treatment procedure was billed.
Action: Write off D9110.
The claim contains only:
D9110 still pays $0.
Action: Do not automatically write it off. Investigate the denial reason.
Exams, cleanings, fluoride, caries-risk assessment, oral hygiene instructions, X-rays.
Fillings and other procedures that restore damaged teeth.
Extractions and other oral-surgery procedures.
Complete dentures and partial dentures.
Root canal treatment and related procedures.
| Code | Procedure | Remember |
|---|---|---|
D0140 | Limited oral evaluation — problem focused | Often used for emergency / specific-problem visits. |
D0150 | Comprehensive oral evaluation | More extensive new / comprehensive exam. |
D0120 | Periodic oral evaluation | Routine recall exam. |
| Code | Procedure |
|---|---|
D1110 | Adult prophylaxis / cleaning |
D1120 | Child prophylaxis / cleaning |
D1206 | Topical fluoride varnish |
D1208 | Topical fluoride application, excluding varnish |
D0601 | Caries risk assessment — low risk |
D0602 | Caries risk assessment — moderate risk |
D0603 | Caries risk assessment — high risk |
D1330 | Oral hygiene instructions |
| Code | Procedure |
|---|---|
D0220 | First intraoral periapical image |
D0230 | Each additional intraoral periapical image |
D0272 | Two bitewing images |
D0274 | Four bitewing images |
D0330 | Panoramic radiographic image |
D0210 | Complete series of intraoral radiographic images / FMX |
| Code | Surfaces |
|---|---|
D2330 | 1 surface — anterior |
D2331 | 2 surfaces — anterior |
D2332 | 3 surfaces — anterior |
D2335 | 4 or more surfaces / incisal angle — anterior |
| Code | Surfaces |
|---|---|
D2391 | 1 surface — posterior |
D2392 | 2 surfaces — posterior |
D2393 | 3 surfaces — posterior |
D2394 | 4 or more surfaces — posterior |
| Code | Surfaces |
|---|---|
D2140 | 1 surface |
D2150 | 2 surfaces |
D2160 | 3 surfaces |
D2161 | 4 or more surfaces |
Claim shows #21 BOL. If the patient had the same tooth and same surfaces restored recently, Medicaid may deny it because of a frequency limitation.
Do not automatically charge the patient. Read the denial reason and follow the payer's rules.
| Code | Procedure |
|---|---|
D7140 | Extraction of erupted tooth / exposed root |
D7210 | Surgical extraction of erupted tooth |
D7220–D7241 | Impacted-tooth extraction family — exact code depends on clinical presentation |
D7250 | Removal of residual tooth roots requiring a cutting procedure |
| Code | Procedure |
|---|---|
D5211 | Maxillary acrylic partial denture |
D5212 | Mandibular acrylic partial denture |
D5213 | Maxillary cast-metal-framework partial denture |
D5214 | Mandibular cast-metal-framework partial denture |
| Code | Procedure |
|---|---|
D5110 | Complete denture — maxillary / upper |
D5120 | Complete denture — mandibular / lower |
| Code | Procedure | Posting Reminder |
|---|---|---|
D2740 | Crown — porcelain / ceramic | Often requires prior authorization for Medicaid. |
D2750 | Crown — porcelain fused to high noble metal | Check authorization and EOB reason. |
D2751 | Crown — porcelain fused to base metal | Check authorization and EOB reason. |
D2752 | Crown — porcelain fused to noble metal | Check authorization and EOB reason. |
D2950 | Core buildup | May process separately or deny depending on plan rules. |
D2954 | Prefabricated post and core in addition to crown | Check coverage, authorization, and EOB reason if denied. |
| Code | Procedure | Simple Meaning |
|---|---|---|
D6240 | Pontic — porcelain fused to high noble metal | Fake tooth in the bridge |
D6241 | Pontic — porcelain fused to base metal | Fake tooth in the bridge |
D6242 | Pontic — porcelain fused to noble metal | Fake tooth in the bridge |
D6245 | Pontic — porcelain / ceramic | Fake tooth in the bridge |
D6740 | Retainer crown — porcelain / ceramic | Crown that supports the bridge |
D6750 | Retainer crown — porcelain fused to high noble metal | Crown that supports the bridge |
D6751 | Retainer crown — porcelain fused to base metal | Crown that supports the bridge |
D6752 | Retainer crown — porcelain fused to noble metal | Crown that supports the bridge |
| Code | Procedure | Posting Reminder |
|---|---|---|
D3310 | Root canal — anterior tooth | Usually needs approval / documentation review. |
D3320 | Root canal — premolar tooth | Usually needs approval / documentation review. |
D3330 | Root canal — molar tooth | Usually needs approval / documentation review. |
D3220 | Therapeutic pulpotomy | Check age, tooth type, and payer rules. |
D9110 | Palliative treatment of dental pain — minor procedure | Used for emergency pain relief; check EOB reason if denied. |
| Code | Procedure | Simple Meaning |
|---|---|---|
D4341 |
Periodontal scaling and root planing — four or more teeth per quadrant | Deep cleaning / SRP for 4+ teeth in one quadrant |
D4342 |
Periodontal scaling and root planing — one to three teeth per quadrant | Deep cleaning / SRP for 1–3 teeth in one quadrant |
D4910 |
Periodontal maintenance | Maintenance cleaning after periodontal treatment |
Before taking action, identify what actually happened to the claim. A rejected claim, a denied claim, a corrected claim, a rebill, and an appeal are different situations.
The claim was not accepted or fully processed because of a submission, enrollment, or information problem.
Examples: invalid member information, wrong payer, provider enrollment problem, missing required claim information.
The payer processed the claim but decided not to pay a procedure.
The denial reason determines whether the next step is correction, rebill, reconsideration, appeal, write-off, or manager/biller review.
A claim submitted again using the payer's corrected-claim process because information on the previously processed claim needs to be changed.
Do not assume every denial should be sent as a corrected claim.
Submit the claim again after fixing missing or incorrect information or adding required information.
During the learning period, investigate first, create a task, and contact the biller/manager for resubmission instructions.
A request asking the payer to reprocess or adjust a claim because the payer appears to have processed it incorrectly.
This can sometimes be handled by calling the insurance company.
A formal request asking the payer to reconsider a denial, especially when the office disagrees with a clinical or benefit decision.
Appeals may require a narrative, X-rays, charting, medical documentation, or other records.
Claim says Patient Not Found. You compare the insurance verification image to the Family Module and discover the member ID was entered incorrectly.
Action: identify the correct ID → create an Open Dental task → contact the biller/manager → advise correcting and resubmitting → leave the claim open.
D2740 has a valid, unexpired approval, but Medicaid denied the crown as if no approval existed.
Action: this may be a payer-processing issue → create a task → contact the biller → payer may need a reconsideration/adjustment or the claim may need to be resubmitted with the approval number again.
A payer reviews documentation and denies a procedure as not medically necessary, but the dentist disagrees.
Action: do not simply rebill the same claim repeatedly → create a task → contact the biller → an appeal or peer-to-peer review may be appropriate.
Exam, X-ray, and filling pay. Extraction pays $0.
Action: split the extraction from the paid procedures → post the paid lines → leave the extraction open → investigate → create a task → notify the biller.
An X-ray denies and the office posting policy authorizes the poster to write off unpaid X-ray codes.
Action: post/write off according to policy. A biller task is not required merely to obtain permission the poster already has, unless another claim issue still requires follow-up.
Before you consider an EOB finished, quickly confirm every item below.
