Dental Billing Company
ClaimCarePro is a dental billing company that bills both sides of a dental practice: CDT claims to dental plans, and the medical claims most dental offices leave unbilled — trauma, oral surgery, TMJ and E0486 sleep apnea appliances on the CMS-1500, and Medicare-covered dental with the KX modifier. Full-service billing is 6% of collections with a $1,000/month minimum, month-to-month, no setup fee. Family-owned in Clearwater, Florida, billing since 2010.
What our dental billing services include
Dental claims on CDT codes
Exams, radiographs, prophylaxis, periodontal therapy, restorations, crowns, endodontics and oral surgery coded in CDT and sent on the ADA claim form or the 837D. Tooth numbers, surfaces and quadrants are checked against the procedure before the claim leaves, because a missing surface or an arch code on a tooth-level procedure is one of the most common reasons a dental claim comes back.
Medical-dental cross-coding
When the medical plan should pay — trauma to the teeth or jaw, biopsies of oral lesions, extractions before radiation or a transplant, infection work-ups — the service is cross-coded to CPT or HCPCS with an ICD-10-CM diagnosis and billed on the CMS-1500 to the medical plan first. The dental plan then pays as secondary under coordination of benefits.
Sleep apnea oral appliances (E0486)
A custom mandibular advancement device is billed to Medicare as durable medical equipment under E0486, not as a dental code. It needs a Medicare-covered sleep test showing obstructive sleep apnea, a treating-practitioner evaluation, a device reviewed by the PDAC, the KX modifier and a dentist enrolled as a DMEPOS supplier. Commercial medical plans have their own versions of the same rules.
TMJ and oral surgery billed to medical
Temporomandibular joint evaluation and treatment, fracture stabilization and many oral surgery procedures are medical benefits on most plans. They are billed with E/M and surgical CPT codes, the M26.6- family of TMJ diagnoses and the documentation the medical plan expects, instead of being written off because the dental plan excludes them.
Medicare dental that Medicare actually covers
Medicare excludes routine dental care, but it pays for dental services inextricably linked to covered treatment: oral exams and infection treatment before an organ transplant, heart valve replacement or dialysis for ESRD, dental care around head and neck cancer treatment, and jaw fracture stabilization. Since July 1, 2025 those claims must carry the KX modifier.
Pre-treatment estimates, narratives and attachments
Crowns, buildups, periodontal scaling and root planing and implants are sent with the attachments plans ask for: pre-operative radiographs, periodontal charting and a narrative that answers the plan's own criteria. Pre-treatment estimates go out before the patient is scheduled, so the patient's share is known in advance.
Denial follow-up and patient balances
Frequency denials, downgrades to an alternate benefit, missing-tooth exclusions and waiting-period denials are each traced to the plan clause behind them, corrected or appealed, and explained to the patient. ERAs are posted, secondary dental and medical claims sent, and patient statements go out on a schedule.
Dental credentialing and Florida Medicaid
Network applications for commercial dental PPOs, Medicare Advantage dental vendors and Florida Medicaid dental plans, done by the team that bills the claims. A flat $250 per payer application, or the $1,750 new-practice bundle per provider.
Why dental claims deny — and how we prevent it
The same procedure has two codes and two forms
A dental plan wants a CDT code on the ADA form; a medical plan wants CPT or HCPCS with an ICD-10-CM diagnosis on the CMS-1500. Sending a CDT code to a medical plan, or a medical service to the dental plan only, is how a payable claim becomes a write-off.
The medical plan is primary more often than offices think
Trauma, pathology, infections and oral surgery are frequently medical benefits. Billing the dental plan first uses up the patient's annual dental maximum on a service the medical plan should have paid, and coordination of benefits has to be unwound later.
Frequency limits and alternate-benefit downgrades
Plans cap how often an exam, cleaning, radiograph series or crown on the same tooth is paid, and many pay a composite at the amalgam rate under an alternate-benefit clause. A claim that ignores the patient's history denies, and the patient hears about it after the visit.
Narratives that do not answer the plan's criteria
A crown denial is often a documentation denial: no pre-operative radiograph, no description of the fracture or decay, no periodontal charting for scaling and root planing. The narrative has to answer the plan's published criteria, not restate the procedure.
Oral appliances denied as dental
Medicare pays E0486 only through the DME benefit: a covered sleep test, a PDAC-listed device, DMEPOS supplier enrollment and the KX modifier. A dentist who is not enrolled as a supplier, or who bills the appliance as a dental code, is not paid by Medicare at all.
The KX modifier on Medicare-covered dental
Medicare covers a narrow set of dental services linked to transplants, cardiac valve surgery, ESRD dialysis and head and neck cancer care. Since July 1, 2025 those claims must carry the KX modifier, and the medical record has to show the link to the covered treatment.
Waiting periods, missing-tooth clauses and annual maximums
New-member waiting periods on major services, missing-tooth exclusions on bridges and implants and low annual maximums decide what pays. Checking them at the pre-treatment estimate, not after the crown is seated, is the difference between a collected balance and an argument.
Credentialing gaps by plan and by location
Dental networks credential each dentist and often each office address separately, and Florida Medicaid dental runs through its own plans. A dentist who starts seeing patients before the plan approves the application is out of network for those visits.
Dental billing company cost: in-house vs outsourced
What outsourced dental billing costs here
Full-service billing is 6% of collections with a $1,000 monthly minimum, month-to-month, no setup fee. Aged or denied claims are worked on a 10% contingency, so that work is paid only from what is recovered. The price is published on our pricing page, not quoted after a sales call.
What in-house dental billing costs
An in-house biller is a salary, benefits, training, practice-management and clearinghouse fees and the cost of coverage when that person is out — paid whether claims are paid or not. The fee to outsource is tied to deposits: when collections fall, so does the fee.
Where in-house dental billing usually loses money
Not on the routine cleaning claim. It loses money on the medical crossover nobody bills, the oral appliance billed to the wrong benefit, the narrative that does not meet the plan's criteria and the denial nobody had time to appeal.
Can the company bill medical plans as well as dental?
Ask any dental billing company whether it bills the CMS-1500 side: CPT and HCPCS cross-coding, ICD-10-CM diagnoses, E0486 under the DME rules and Medicare's KX modifier. A company that bills only CDT codes leaves the medical side unbilled.
Will they sign a BAA, and can you leave?
Any company handling your patients' claims should sign a Business Associate Agreement before it sees a record. ClaimCarePro signs a BAA and bills month-to-month with no setup fee and no exit fee. Long terms and termination penalties are the red flag.
Who is behind the work?
ClaimCarePro is a family-owned billing company in Clearwater, Florida, billing since 2010, with 30+ years combined billing experience, a bench of experienced part-time billers scaled onto accounts as needed, and AI automation that checks each claim before it goes out.
How we take over your dental billing
- 1
Free claims and A/R review
We review 90 days of claims, remittances and aging for frequency and downgrade denials, unbilled medical crossovers, missing narratives and attachments, and Medicare dental claims missing the KX modifier.
- 2
Recover the aged and denied claims
Denied crowns and periodontal claims re-sent with the documentation, medical crossovers billed to the medical plan inside its filing limit, and secondary claims sent — on a 10% contingency while new claims start.
- 3
Map every plan and every dentist
Each dentist's network status confirmed by plan and location, fee schedules loaded, and the medical plans and DMEPOS enrollment that oral appliances need checked before the first claim.
- 4
Daily coding and claim checks
Procedures coded from the signed note, tooth and surface data validated, frequency history checked, attachments added, and the dental or medical claim sent the day the service is completed.
- 5
Posting, follow-up and reporting
ERAs posted, denials worked by cause, coordination of benefits handled between medical and dental plans, patient balances billed, and a monthly report by dentist, location and plan.
- 6
Credentialing kept current
New dentists enrolled before their first day, location changes filed with each plan, and re-credentialing tracked so no plan lapses.
Dental billing company: questions buyers ask
How much does a dental billing company cost?
Is it cheaper to outsource dental billing or keep it in-house?
Can a dentist bill a medical insurance plan?
What is the difference between CDT and CPT codes?
How do you bill Medicare for a sleep apnea oral appliance?
Does Medicare pay for any dental services?
Why do dental insurance claims get denied?
Do you bill Florida Medicaid dental plans?
Can you bill TMJ treatment to medical insurance?
How do you switch dental billing companies without losing claims?
See what your dental claims are leaving unpaid
Last updated October 29, 2026. Reviewed by Jacob Greenberg, founder, ClaimCarePro. Send us 90 days of claims and remittances and we will show you the denied crowns and periodontal claims, the medical crossovers never billed and the Medicare claims missing the KX modifier that can still be corrected. Billing is 6% of collections, month-to-month, no setup fee.
Related resources
Dental credentialing
Where a dentist applies for each kind of plan, Florida Medicaid dental and Medicare rules.
Learn morePricing
Every ClaimCarePro price in one place: billing, A/R recovery and credentialing.
Learn moreMedical billing services
What full-service billing covers on the medical side of a dental practice.
Learn moreCredentialing services
Published pricing for dental, medical, Medicaid and Medicare enrollment.
Learn moreDME billing services
The DMEPOS rules an oral appliance is billed under: supplier enrollment, modifiers and orders.
Learn moreFree A/R audit
Send 90 days of claims and remittances; we show what is still recoverable.
Learn more