Dental Billing and Coding- A Guide for Small Dental Practices
                     Dental Billing and 
Coding: A Guide for 
Small Dental 
Practices
• Running a dental practice entails so much more 
than offering your patients great care. To have a 
seamless practice, you need to attend to other 
administrative tasks such as dental billing and 
coding. However, these can be so complex that 
it eats into the productive time of dental 
practitioners, especially in small practices.
• That said, knowing the fundamentals of dental 
billing and coding can help smoothen 
operations, bring about timely reimbursement, 
and improve cash flow in your dental practice.
• In this article, we’re going to break down the 
essentials of dental billing and coding. We will explain 
crucial concepts, such as dental procedure codes, 
diagnosis codes, and many others, before showing 
how partnering with experts like PMN can make a 
difference for your dental office.
What is Dental Medical Billing 
and Coding?
• This is the method of translating dental procedures 
into standard codes—primarily aimed at billing for 
insurance claims. For this, there are mainly two major 
steps:
• Dental Coding: This means giving a set of appropriate 
dental procedure codes, most often from Current 
Dental Terminology or the CDT code set, developed 
by the American Dental Association, and the 
respective diagnosis code that describes the dental 
services provided to the patients.
• Dental Billing: Once accurate code assignment is 
performed, a claim is prepared and submitted to the 
dental payers—insurance companies—so your dental 
practice gets paid for the provided services.
• Results: Effective dental billing and proper coding of 
dental claims are the backbones to keep your dental 
office financially healthy. Poor coding and submission
    of claims result in delayed payments, denials, and 
loss of revenue that may strike deep into the bottom 
line of any practice.
Why Proper Dental Coding is 
Important
• Bad dental coding will lead to multiple problems for 
your dental practice. A wrong coded dental 
procedure code or diagnosis code might lead to 
denial, rejection, or audit of the claim. For example, 
failure to establish medical necessity for a particular 
procedure only because of poor documentation 
might get the claim rejected by the insurance carrier 
for reimbursement.
• The other reason is because dental coding has 
become so complex these past years that it requires 
some specialized training on the part of a coding 
expert. Sometimes, the American Dental Association 
updates the Current Dental Terminology, and your 
team needs further education or even a coding 
course to stay compliant.
Key Roles in Dental Billing and Coding
• Medical billing and coding management requires 
well-trained physicians with an understanding of the 
fine details in the process. A small dental practice 
must require expertise in relevant fields on board, a 
certified dental billing specialist, or a certified dental
    coder and specialist medical doctors. An expert in the field 
brings the following to your practice:
• Special Training: They have undergone rigorous training and 
coding courses to accurately apply dental procedure codes 
and diagnosis codes.
• Attention to Detail: They ensure that all claims submitted 
from them meet the insurance requirement by clearly 
documenting the medical record to substantiate medical 
necessity.
• Relevant Knowledge: They also keep current with changing 
information about standards in coding and payer 
requirements for compliance with regulations.
• Smaller practices face huge difficulties and high costs in 
finding this particular skill set and staffing. This is where 
outsourcing can make the biggest difference.
The Benefits of Partnering with a 
Medical Billing Service like PMN
• If your dental practice has an inefficient method of 
billing and coding, then outsourcing to a trusted 
medical billing service like PMN will help in many 
ways.
• Expertise You Can Trust: PMN is staffed with 
certified dental billing specialists and coding 
specialists who have 20+ years of experience and 
specialized training in the field. They understand all 
the intricacies of dental claims, tirelessly working 
toward their accuracy and compliance.
• Save Time: This will leave your team free to attend to 
great dental work while PMN looks after the 
administrative chores, preparation, and submission 
of claims.
• Improved Cash Flow: PMN ensures your claims are 
properly coded, submitted on time, and followed up 
with to minimize delays and denials. Your 
reimbursements are faster, meaning financial 
stability for your dental office.
• Affordability: This might prove to be pretty budget-
friendly for small-scale dental practices instead of 
keeping and training full-time employees for medical 
billing. PMN has customized solutions designed to 
meet your office’s every need.
• Pairing with PMN allows you to automate your 
billing process so that you minimize errors and 
ensure timely payment. Be it complex coding or 
the resubmission of claims, PMN has a team of 
certified professionals who can deliver services, 
thus giving peace of mind to your healthcare 
organization and time to grow your practice.
• Want to learn more about our services? Reach 
out to us today by calling (949) 215-5055. If you’d 
prefer chatting in-person, don’t hesitate to visit 
our office in Laguna Hills, Orange County, 
California.
Staying Compliant with Dental 
Payers and Regulations
• Compliance with dental payers and insurance 
requirements is important for the successful 
running of a dental practice. Most insurance 
companies are quite strict in terms of 
documentation and coding accuracy. Claims are 
supposed to establish the medical need through 
clear medical records and proper diagnosis codes.
• Not adhering to a payer’s requirements may result 
in denials or even audits. To stay compliant:
– Follow Current Dental Terminology updates and 
training for your staff on an ongoing basis.
– Work with certified dental coders with knowledge of 
the payer guidelines.
– Collaborate with medical billing services like PMN in 
claims submission and compliance review.
• If proper processes like these are in place, you will 
not suffer much from those mistakes that disrupt 
your dental practice.