Dental practices are increasingly expanding into medical billing to gain reimbursement for medically necessary procedures—especially those related to oral surgery, sleep apnea, TMD, or trauma-related care. However, most dental offices struggle with the complexities of medical billing for dental procedures, including the use of CPT, ICD-10 codes, and modifier combinations not typically used in traditional dental billing systems.
Maximize Collections for Your Dental Practice
At Smart RCM Solutions, we help dental practices unlock new revenue by accurately billing medical insurance for eligible procedures, reducing out-of-pocket costs for patients, and streamlining your entire RCM process.
Dental Procedures That Can Be Billed to Medical Insurance
Not all dental services are eligible for medical insurance reimbursement, but several categories are, especially when procedures are:
- Medically necessary
- Related to systemic conditions
- Due to trauma or congenital defects
- Tied to sleep-disordered breathing or TMD
Examples of Billable Dental Procedures:
🦷 Surgical Extractions (especially impacted teeth)
💤 Oral appliances for sleep apnea (e.g., mandibular advancement devices)
💥 Trauma-related dental reconstruction
💀 TMJ/TMD treatment
🩻 3D cone beam CT scans
🦷 Biopsies of oral lesions or masses
🩺 Pre-prosthetic surgical procedures
🧠 Dental clearance for medically compromised patients
What We Offer – Medical Billing for Dentists
✅ Procedure-to-Code Matching
We translate dental procedures (CDT) into accurate medical codes (CPT, ICD-10, HCPCS) for insurance submission.
✅ Sleep Apnea Appliance Billing
We handle billing for oral appliances (E0486) used in obstructive sleep apnea therapy, including pre-authorization.
✅ Surgical Case Support
Our coders manage everything from wisdom tooth removals to bone grafts and biopsy documentation for accurate reimbursement.
✅ Medical Necessity Documentation
We guide you in compiling proper SOAP notes, radiographs, and diagnostic justifications required by payers.
✅ Medical-Dental Coordination
We submit claims directly to medical payers and follow up persistently to secure reimbursement—even when a dental plan doesn’t apply.
✅ Pre-Authorizations and Appeals
We handle the paperwork to get procedures pre-approved and fight denials with detailed appeals and clinical documentation.
Common CPT & HCPCS Codes Used in Dental Medical Billing
| Code | Description |
|---|---|
| D7140 → 41899 | Simple extraction → Unlisted dental procedure |
| E0486 | Oral appliance for sleep apnea |
| 21248 | Reconstruction of mandible with graft |
| 70486 | CT scan of maxillofacial area |
| 41874 | Biopsy of oral mucosa |
| 21085 | Custom dental prosthesis (non-orthotic) |
| D7210 → 41899 | Surgical extraction → Unlisted CPT code |
Note: Many dental CDT codes must be mapped to CPT equivalents when billing medical.
We Work With:
🦷 General Dentists
👄 Oral & Maxillofacial Surgeons
😴 Dental Sleep Medicine Clinics
💥 Craniofacial Trauma Specialists
🧘 TMD & Orofacial Pain Specialists
Why Dentists Trust Smart RCM Solutions
✅ Trained in Both CDT & CPT
Our team understands the overlap between dental and medical coding systems.
✅ Increased Patient Acceptance
Billing medical for oral appliances or surgery lowers patient cost and improves case acceptance.
✅ All Payer Support
We bill Medicare, Medicaid, BCBS, Aetna, UnitedHealthcare, and other major carriers—nationwide.
✅ Compliance With HIPAA & ADA Guidelines
We follow all federal guidelines to ensure accurate, legal, and ethical billing practices.
✅ Easy Integration
Whether you use Dentrix, Eaglesoft, Open Dental, or another platform—we integrate seamlessly.
FAQs – Dental Medical Billing
Q: Can I bill both dental and medical insurance?
Yes. For certain medically necessary procedures, you can submit claims to medical first and dental second (if needed).
Q: What types of dental services qualify for medical billing?
Services related to trauma, infection, sleep apnea, biopsies, or jaw surgery typically qualify.
Q: Is pre-authorization required?
Yes, most medically billable dental procedures require prior authorization. We handle this for you.
Q: Will insurance pay for sleep apnea appliances?
Yes, most medical insurers cover E0486 appliances with a sleep study and physician prescription.
Q: Can I use CPT codes in my dental software?
While most dental systems use CDT, our team can generate CPT claims separately or integrate with external medical billing software.
Make Medical Billing Work for Your Dental Practice
If you’re not billing medical for eligible dental services, you’re leaving revenue on the table and increasing the burden on your patients. Smart RCM Solutions empowers dental providers to expand their reimbursement channels with full-service medical billing tailored to your clinical scope.
📞 Call Us Today: +1-725-245-5971
📧 Email: [email protected]
🌐 Website: www.SmartRCMSolutions.com