Adhering to New Dental Codes Brings Financial Benefits

Is the person responsible for billing at your practice current on the new dental codes? There are more than a handful of changes that took place January 1, 2018. And if your practice is still using old codes, that's likely costing you money in the form of lost revenue. But it doesn't have to be that way. Update courses can help your staff stay current and keep your practice profitable.

Are more dental practices filing insurance claims? Alvarez says it depends on the geographic location of the practice.

At the start of 2018, the American Dental Association added 18 new codes and deleted three others from the Code on Dental Procedures Nomenclature. Is your staff current with these changes? If not, it could mean lost revenue for your dental practice.

“It comes down to production, and making a profit,” says Nicole Alvarez, program director at CBD College, and a member of the California Association of Dental Assistant Teachers.

Alvarez explains that if the staff member responsible for billing is not up-to-date on codes, one of two things is going to happen. The practice will not get paid, or it will get paid an old fee for the previous year, and that can hurt.

“So, it all comes down to the bottom line,” she emphasizes, “and production.”


Alvarez says it’s critical that practices have billing staff attend training sessions on billing and coding so they are well versed in all the latest changes. Most colleges that offer medical billing and coding training also have an in-depth module on dental codes. Who should be trained?

“For sure the office manager, if the office manager is in charge of billing,” Alvarez says. “If the practice has an office manager who’s more administrative and has a delegated person for billing, then that’s the individual who needs to know. The back office dental assistant would need to have entry-level knowledge in case the office manager is out ill.”

But understanding codes is more than just memorizing numbers, Alvarez stresses. It’s important to understand coverage and cross coding because there are different codes that can be used for multiple procedures.

For example, Alvarez recalls working for a general dentist who specialized in treating disorders of the temporomandibular joint. As such, he saw many patients for trigger point injections, making mouthpieces that would ease the pressure on their jaw.

“A lot of that went through medical insurance,” she says.

A colleague of the dentist where Alvarez was employed see patients for sleep apnea and would make appliances to help open the patient’s airway and alleviate their snoring.

“That crosses over from medical as well.”


Are more dental practices filing insurance claims? Alvarez says it depends on the geographic location of the practice. For example, in a small town like Bakersfield, California, which is her hometown, virtually every dental practice uses insurance. However, in larger cities where there are more high-end practices doing large restorative cases, there’s less desire to operate on an insurance schedule.

“They tell patients, ‘We’ll do the work, you pay us cash, and then you can bill your insurance for the reimbursement,’” Alvarez says. “They kind of put it on the patient.”

Many practices in the Los Angeles area do the same, she says. They don’t want to deal with insurance; don’t want anyone telling them what they can charge for certain procedures. So the patient pays up front and is provided with all the information they need to bill their insurance company for reimbursement.

“It really just depends on the market and the location,” she says.


Alvarez believes it’s important for all dentists to encourage their staff to attend training sessions and stay up-to-date on changing codes.

“All dental assistants who are registered in California have to attend continuing education courses,” she says.

Those courses are centered on back office procedures and new techniques in dentistry. But for front office staff, similar workshops are few in number.

“So I would encourage dentists to send whoever is responsible for their billing to any update seminars each year so that they can stay current, and in turn create more revenue for the practice.”

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