Medical Billing for Dental Care: An Advocate’s View
Collaborating With Providers to Bridge Care, Coverage & Compliance
At The Advocate’s Corner, we believe the strongest patient outcomes happen when patients, providers, and advocates collaborate—not operate in silos. This edition brings together advocacy + medical billing for dental care, showing how the right systems improve access, trust, and outcomes—while ensuring offices are paid accurately and compliantly.
What Collaboration in Healthcare Advocacy Really Means
Collaboration means meeting patients where they are and supporting provider offices where they need help most—especially when care crosses the dental–medical boundary.
At National Dental Advocacy Program® (NDAP), we act as the bridge:
Between patients and providers
Between dental offices and medical insurance
Between clinical care and compliant reimbursement
Our purpose is to reduce friction, confusion, and delays—so treatment doesn’t stall and offices aren’t left unpaid.
Who We Are & Why Credentials Matter
NDAP advocates are not general assistants. We are highly trained professionals with deep expertise in advocacy, billing, and compliance.
Our Team Includes
Board-Certified Patient Advocates (BCPA)
Certified Dental Billing Specialists
Certified Dental Coders
Medical Billing–Certified Advocates
This rare combination allows us to understand patient rights and provider operations—a critical intersection when navigating medically necessary dental care
Medical Billing for Dental Care: An Advocate’s View
As advocates, we see patients delay or decline necessary treatment not because they don’t need it—but because they fear the cost. When medical billing is implemented correctly, it becomes a care access solution, not just a revenue strategy.
Our Areas of Specialty
Many dental services may qualify under medical insurance when medical necessity is properly documented, including:
Occlusal splints (TMD related)
Consultations
Oral Appliance Therapy/Sleep Medicine
CT scans & diagnostic imaging
Medically necessary orthodontics
Oral surgery–related medical claims
We don’t guess. We apply ICD-10 diagnosis codes, CPT procedure codes, and payer rules accurately and compliantly.
How Medical Billing Improves Patient Care
1) Expands Access to Medically Necessary Treatment
Patients can proceed with care affecting airway, pain, function, infection, trauma, or systemic health
Decisions are based on medical need, not financial fear
Delayed care—and its complications—are reduced
2) Supports Informed, Patient-Centered Decisions
Advocacy means education and transparency:
Patients understand why care is medically necessary
They see how diagnoses connect to treatment
Confidence and follow-through improve
3) Reduces Emotional & Financial Stress
Lower out-of-pocket costs
Reimbursement options after care
Prior authorizations before treatment when possible Knowing there’s a pathway forward brings immediate relief.
Benefits for Dental Practices (That Also Help Patients)
4) Ethical, Confident Care Delivery
Providers recommend treatment based on clinical necessity
Better documentation supports care and compliance
Less under-treatment driven by coverage uncertainty
5) Continuity of Care
SOAP-format clinical notes support medical necessity
Imaging, consults, and diagnostics are captured correctly
Fewer interruptions, denials, and surprises for patients
6) Stronger Patient–Provider Trust
Patients notice when offices:
Explain coverage pathways
Advocate for reimbursement
Partner with professional advocates Trust grows—and so does loyalty.
Two Pathways NDAP Uses to Support Care & Coverage
Pathway 1: Patient-Driven Reimbursement
NDAP works directly on behalf of the patient after services are rendered:
Review documentation for medical necessity
Help create or review a Superbill
Submit medical claims or reimbursement requests
Communicate with insurers
Help patients recover out-of-network reimbursement
This empowers patients while reducing administrative burden on offices.
Pathway 2: Provider-Driven Pre-Treatment Support
Before treatment begins, practices can engage NDAP for single-case or ongoing support:
Identify applicable ICD-10 & CPT codes (cross-coding is our specialty)
Verify benefits & obtain full breakdowns
Support or submit prior authorizations
Bill medical claims on behalf of the practice through our clearinghouse
Track claims through authorization and submission
If a practice lacks medical billing infrastructure, NDAP steps in as an extension of the team.
Documentation Is the Foundation—Always
No matter the pathway, the initial steps are the same:
✔️ Thorough SOAP-format clinical notes
✔️ Clear documentation of medical necessity
✔️ Supporting records, including: CT scans & imaging, Consultation notes, Treatment rationale
These services and records are often reimbursable—when done correctly.
Examples of Medical Billing for Dental Care
Common ICD-10 Diagnoses, CPT Procedures & Covered Treatments
The examples below are provided by the National Dental Advocacy Program® (NDAP) solely for general educational and advocacy purposes. They are intended to help patients and dental professionals understand how certain dental-related services may intersect with medical insurance when medical necessity is properly documented.
NDAP does not own, license, sell, or distribute ICD-10 or CPT codes, nor does NDAP provide coding services as a billing vendor. All codes referenced are publicly available identifiers used for illustrative discussion only. Coverage determinations are payer-specific and plan-specific and are made solely by the health plan.
Advocacy Note: The presence of a diagnosis or procedure code does not guarantee insurance coverage or payment. Medical insurers rely on clinical documentation, SOAP-format notes, diagnostic findings, and medical necessity rationale when making determinations.
1) TMD / Orofacial Pain
Common ICD-10 Diagnosis Examples
M26.62 – Arthralgia of temporomandibular joint
M26.609 – Temporomandibular joint disorder, unspecified
G47.63 – Sleep related bruxism
R68.84 – Jaw pain
Examples of CPT Identifiers Referenced by Medical Plans
Impression and custom fabrication of oral orthotic (commonly used for occlusal splints)
Evaluation & management (consults/follow-ups)
Often Covered When Medically Necessary
Occlusal/TMD splints
TMD evaluations and follow-ups
Conservative pain management related to jaw dysfunction
2) Diagnostic Imaging (CBCT / CT Scans)
Common ICD-10 Diagnosis Examples
R93.0 – Abnormal findings on diagnostic imaging of skull and head
K07.6 – Temporomandibular joint disorders
S02.5XXA – Fracture of tooth (when tied to trauma)
Examples of CPT Identifiers Referenced by Medical Plans
CT maxillofacial area without contrast
CT maxillofacial with contrast (when indicated)
Often Covered When Medically Necessary
CT/CBCT imaging tied to trauma, pathology, airway concerns, or surgical planning
Imaging supporting medical diagnoses—not routine dental screening
3) Oral Surgery & Trauma-Related Care
Common ICD-10 Diagnosis Examples
K12.2 – Cellulitis and abscess of mouth
S02.609A – Fracture of mandible, unspecified
K08.89 – Other specified disorders of teeth and supporting structures
Examples of CPT Identifiers Referenced by Medical Plans
Unlisted procedure, dentoalveolar structures
Treatment of mandibular fractures
Surgical consults
Often Covered When Medically Necessary
Trauma-related oral surgery
Infection-driven procedures
Hospital-based or medically indicated interventions
4) Medically Necessary Orthodontics (Non-Cosmetic)
Common ICD-10 Diagnosis Examples
M26.4 – Malocclusion, unspecified
Q35–Q37 – Cleft lip and/or palate
G47.33 – Obstructive sleep apnea (when orthodontics support airway)
Examles of CPT Identifiers Referenced by Medical Plans
Surgical correction of jaw deformities
Multidisciplinary consults
Often Covered When Medically Necessary
Orthodontic treatment related to craniofacial anomalies
Airway-compromising malocclusions
Adjunctive orthodontics tied to surgical or medical treatment plans
5) Consultations & Care Coordination
Examples of CPT Identifiers Referenced by Medical Plans
New patient consultations
Established patient visits
Interprofessional consults (when applicable)
Often Covered When Medically Necessary
Medical consults supporting diagnosis and treatment planning
Documentation review and coordination with physicians or specialists.
References to CPT codes are provided for general educational and advocacy purposes only. CPT is a registered trademark of the American Medical Association. NDAP does not provide coding services or guarantee insurance coverage.
Why This Matters for Patient Care
From an advocacy standpoint, using medical billing appropriately:
✔️ Expands access to necessary treatment
✔️ Reduces out-of-pocket costs
✔️ Prevents delays that worsen conditions
✔️ Supports informed consent with financial clarity
When patients understand why care is medically necessary—and how it may be covered—they are far more likely to proceed with treatment.
Compliance, HIPAA & Patient Rights
Collaboration must always be compliant:
Patients have the right to access their records
HIPAA defines timeframes for release
Medical insurers commonly request a Superbill
What Is a Superbill?
A Superbill typically includes:
Patient & provider details
ICD-10 diagnosis codes
CPT procedure codes
Dates of service & charges
Provider credentials & signatures
NDAP ensures Superbills are accurate, complete, and compliant, protecting patients and practices alike.
How NDAP Supports These Cases
At National Dental Advocacy Program (NDAP), we support both pathways:
Patient-driven reimbursement after services are rendered
Provider-driven pre-treatment support, including benefits verification, authorization, and medical claim submission—even billing on behalf of the practice when needed
Our goal is simple: help patients move forward with care while helping providers get paid—ethically and compliantly.
Call to Action
🔹 Providers: Want help identifying medical billing opportunities for your patients?
🔹 Patients: Unsure if your dental treatment qualifies under medical insurance?
👉 Connect with NDAP to review your case and explore advocacy-driven medical billing support.
