Case File #003: Medical Billing in Dentistry- The Untapped Revenue Stream That Changes Patient Care
For many dental providers, medical billing feels discouraging—not because it doesn’t work, but because it doesn’t deliver instant gratification.
I see it every day.
Offices inquire about one or two patients' medical benefits, don’t see immediate results, and assume medical billing “isn’t worth it.” From the provider side, impatience often replaces curiosity. From the patient side, access to care quietly disappears.
From the front lines, I want to be clear:
Medical billing for dental procedures works—when it is done correctly, compliantly, and as part of a system.
As a certified dental-medical biller, dental billing consultant, and the founder of a nationwide nonprofit helping patients obtain reimbursement for dental procedures through medical insurance, I am actively involved in claims at every stage—from intake to appeal.
Based on real data, not theory:
Approximately 99% of properly submitted medical-dental claims are being paid when I am wearing my patient advocate hat, because patients are properly vetted, and the diagnosis attached to the treatment provided is authorized (as it should be) before even sending the claim!
That includes not only the dental procedure itself, but also the associated imaging, exams, and diagnostics that support medical necessity.
And in many cases, the reimbursement received through medical insurance is significantly higher than what the same procedure would pay under a PPO-contracted dental plan.
This is not a loophole. This is not experimental. This is simply a system most dental practices were never taught to implement.
Medical Billing Is Not Just Revenue—It’s Access to Care
Medical billing in dentistry is often framed as a financial opportunity, but that framing misses the bigger picture.
When patients are able to use their medical insurance for medically necessary dental care, several things happen:
Treatment acceptance increases
Financial hesitation decreases
Patients receive care sooner
Oral health outcomes improve
Dentistry aligns with whole-body healthcare
For many patients, medical reimbursement is the deciding factor between moving forward with treatment or delaying care indefinitely.
When dentistry is treated as isolated from systemic health, patients lose. When dentistry is integrated into healthcare, patients win.
Why Practices Get Stuck (And Why It’s Understandable)
Most dental offices struggle with medical billing because they attempt to apply it after treatment, rather than building it into their workflows from the beginning.
Medical billing does not start at claim submission. It starts at the first phone call and every recall visit thereafter.
Successful medical billing requires:
Updated medical histories at every visit
Accurate medication lists
Identification of systemic conditions
Flagging diagnoses that trigger medical billing protocols
Clinical documentation that clearly tells the patient’s story
Without systems, medical billing feels overwhelming. With systems, it becomes routine.
This is why working with specialists who understand both dental and medical billing is critical. Systemization is what transforms medical billing from an intimidating process into second nature.
Medical & Dental Billing Begins With Clinical Context—Not Loose Notes
Billing accuracy is built on documentation. And documentation is how the patient’s clinical picture is clearly communicated.
The process starts before the patient ever arrives.
When a patient contacts the office to schedule, your team should already be collecting information that will later support treatment decisions, documentation, and reimbursement:
Are you experiencing pain, discomfort, or functional limitations?
Were you referred by another provider or specialist?
An updated medical history will be required prior to your visit
This information forms the foundation of the subjective portion of the clinical record.
Quick reminders, verbal relays, or partial histories are not reliable documentation — they create exposure.
A thorough, up-to-date medical history serves multiple purposes beyond billing:
It supports accurate diagnosis
It identifies additional preventive or hygiene-related benefits
It lowers clinical and legal risk
It safeguards both the provider and the patient
Clear, complete documentation strengthens clinical decision-making — and strong clinical decision-making leads to better care.
ICD-10 Diagnosis Coding Should Be Standard in Dentistry
Medical billing cannot exist without diagnosis—and diagnosis elevates the standard of care.
I strongly believe that every dental practice should be using ICD-10 diagnosis codes as part of routine documentation, even when billing dental insurance.
Diagnosis coding forces dentistry to move beyond procedures and into clinical reasoning tied to whole-body health.
Diagnosis hierarchy matters:
Primary diagnosis – the underlying medical condition (diabetes, trauma, sleep apnea)
Secondary diagnosis – the resulting oral condition (periodontal disease, bone loss, tooth loss)
Tertiary diagnosis – signs and symptoms (pain, swelling, infection)
This structure strengthens dental claims, medical claims, and patient records alike.
Dental Procedures Commonly Covered by Medical Insurance
Medical insurance frequently covers dental procedures when medical necessity is properly documented, including:
Surgical extractions related to infection or trauma
Oral surgery tied to systemic conditions
Occlusal splints for TMJ or sleep-related disorders
Medically necessary orthodontics (YES IT’S TRUE!)
Full mouth rehabilitation connected to medical diagnoses
Imaging, exams, and diagnostics associated with these treatments are often covered as well—when documentation supports the story.
Common ICD-10 Codes Used in Dental Medical Billing
Examples of ICD-10 codes frequently used in dental medical billing include:
E11.9 – Type 2 diabetes mellitus without complications
G47.33 – Obstructive sleep apnea
M26.609 – Temporomandibular joint disorder
R68.84 – Jaw pain
K08.109 – Partial loss of teeth due to trauma
These codes bridge dentistry and medicine—and unlock reimbursement appropriately.
This Is the Future of Ethical, Elevated Dentistry
Medical billing is not about shortcuts or chasing payments. It is about systems, accuracy, and advocacy.
When implemented correctly, medical billing:
Expands access to care
Improves patient outcomes
Strengthens compliance
Elevates the standard of care
Increases revenue ethically
This is not optional dentistry. This is integrated healthcare.
If you work with the right team and the right billers, medical billing becomes a natural extension of your practice—not something to fear.
Whole-body oral healthcare is here. The only question is whether your systems are ready for it.
-The Dental Detective™ with Elite Dental Systems at elitedentalsystems.com
Medical Billing • RCM • Systems Consulting
📧 contact@elitedentalservices.net
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