Expert dental billing, insurance verification, credentialing and A/R management for dental practices across the U.S. — so you collect more of what you earn and your front desk spends less time on hold with insurance companies.
Dental insurance is built differently from medical insurance — annual maximums, frequency limits, waiting periods, missing-tooth clauses, downgrades and alternate benefits all change what a plan actually pays. When benefits aren't verified correctly or a claim goes out without the right attachment, the result is a denial, a surprised patient and an account that sits in A/R for months.
Provider Concerns Solutions takes the insurance side of your practice off your front desk. Our dental billing specialists verify benefits before the appointment, code every procedure with current CDT codes, submit clean claims with the right documentation, post payments accurately and follow up on every unpaid claim until it's resolved.
We check last-service dates for prophys, bitewings, FMX and fluoride before the visit, not after the EOB.
Pre-op X-rays, perio charts and clinical narratives are attached at submission, the first time.
Every open claim is worked on a schedule, with appeals filed before timely-filing limits expire.
Credentialing and re-credentialing are tracked so new providers can bill in-network as soon as possible.
From the moment a patient books to the day the last dollar is posted, we handle every step of the dental billing cycle — individually or as a full-service package.
A full breakdown of each patient's dental coverage before treatment, entered into your practice management system.
Accurate CDT coding and complete attachments submitted electronically on the ADA claim form or 837D.
Insurance and patient payments posted accurately so every ledger reflects what really happened.
Consistent follow-up on unpaid, underpaid and denied claims to shrink days in A/R.
Payer enrollment and re-credentialing handled and documented for future use.
A detailed review of your current billing to find missed revenue, coding problems and fixes.
A simple, transparent workflow that plugs into the software and schedule you already have.
We analyze collections, denials and aging A/R.
BAA signed, PMS access set up, payer list mapped.
Benefits checked, CDT codes and attachments prepared.
Clean claims sent, every open claim worked to resolution.
Regular reports on collections, A/R and denials.
Most dental denials can be traced back to something that was knowable before the patient sat down. Our verification team contacts the payer or uses the payer portal to confirm eligibility and builds a full benefit breakdown — not just "active / inactive."
Your front desk gets an accurate estimate for treatment planning, and the patient knows their portion before treatment begins.
The ADA updates Current Dental Terminology every year, adding, revising and deleting codes. Using an outdated code or the wrong code for the documented treatment is one of the fastest routes to a denial or a downgrade.
We match each code to your clinical notes, apply the right tooth numbers, surfaces and quadrants, and attach what the payer will ask for.
Some dental procedures qualify for the patient's medical plan when they're medically necessary. Billing those correctly means translating CDT codes to CPT and ICD-10 and submitting on a CMS-1500 / 837P with the right documentation.
This is especially valuable for oral surgery and dental anesthesiology practices, where medical coverage can be the primary payer.
Every claim without a response is followed up on a set schedule. Denials are categorized by root cause so the same mistake doesn't happen twice, and corrected claims or appeals go out well before timely-filing deadlines.
You get a clear aging report showing what's open, why, and what we're doing about it.
Each specialty has its own codes, payers and documentation rules. We bill for:
Preventive, restorative & prosthetic claims.
Medicaid/CHIP, sealants, fluoride & SDF.
Dental + medical cross-coding.
Sedation time units & medical billing.
FQHC & community clinic billing.
| Area | Typical in-house billing | Provider Concerns Solutions |
|---|---|---|
| Insurance verification | Squeezed between phone calls and check-ins | Full breakdown completed before the appointment |
| Coding updates | Depends on one staff member keeping up | Updated with every annual CDT release |
| A/R follow-up | Worked when there's time | Worked on a fixed schedule by aging bucket |
| Staff turnover | Billing knowledge leaves with the employee | A dedicated team with documented processes |
| Reporting | Pulled manually, if at all | Regular collections, denial & A/R reports |
| Credentialing | Applications tracked in email | Documented and tracked through approval |
Dental billing is the process of turning the treatment a dentist provides into payment from insurance carriers and patients. It covers everything from verifying a patient's insurance before the appointment, to coding procedures with CDT codes, submitting claims, posting payments, following up on unpaid claims and collecting patient balances. Together these steps make up the dental revenue cycle.
When any step is rushed or skipped, revenue leaks out of the practice: claims get denied, payments arrive late, patients receive unexpected bills and accounts age past the point where they can be collected.
Although both involve insurance claims, dental and medical billing follow different rules:
Current Dental Terminology (CDT) is the code set maintained by the American Dental Association and required under HIPAA for reporting dental procedures. Codes begin with "D" followed by four digits and are grouped into categories such as diagnostic (D0100–D0999), preventive (D1000–D1999), restorative (D2000–D2999), endodontics, periodontics, prosthodontics, implants, oral surgery and orthodontics.
Because CDT is revised every year, billing teams need to update their code sets and fee schedules each January. Using a deleted code or the wrong code for the documented treatment can lead to denials, downgrades or audit risk.
Nearly all of these are preventable with thorough benefits verification and a consistent claim-scrubbing process before submission.
The share of collectible production (after contractual adjustments) that the practice actually collects. A falling collection rate is often the first sign of a billing problem.
How long, on average, it takes to get paid after a procedure. Rising days in A/R point to slow submission or weak follow-up.
The percentage of claims paid on first submission without rework. This measures how clean your claims are going out the door.
Tracking denials by cause shows exactly where the process is breaking — verification, coding, documentation or filing.
Balances older than 90 days are much harder to collect. Keeping this bucket small protects your cash flow.
Before you outsource, ask any dental billing partner:
At Provider Concerns Solutions, we start with a free dental billing review so you can see exactly where your revenue is going before making any commitment.
Yes. Every dental claim is coded with the current year's CDT (Current Dental Terminology) codes published by the ADA. We update code sets each January, match codes to documented treatment, and attach the X-rays, perio charts and narratives payers require.
Yes. When a procedure is medically necessary — such as oral surgery, trauma, sleep apnea appliances or biopsies — we cross-code CDT to CPT and ICD-10 and submit on a CMS-1500 or 837P to the patient's medical plan, with the supporting documentation.
Yes. We handle new payer enrollment, CAQH profile setup and maintenance, re-credentialing and fee schedule requests, and keep a documented record of every application for future use.
We work inside the dental practice management system you already use, so your team does not need to change software or workflows.
We follow HIPAA requirements, sign a Business Associate Agreement (BAA) with every practice, and use role-based, access-controlled connections to your systems.
We review your current collections, denial reasons and aging A/R, then show you where revenue is being lost and what to fix first. There is no obligation.
Get a free billing review. We'll look at your current collections, denials and A/R and show you exactly where revenue is being lost — and how to recover it.