A Step-by-Step Guide to Billing Medical Insurance for Dental Procedures

Billing medical insurance for dental procedures is something every oral surgeon should be doing—because let’s face it, your work goes far beyond fillings and cleanings. You’re not just treating teeth; you’re managing trauma, addressing systemic infections, and diagnosing complex conditions that affect far more than the oral cavity. Yet despite how often your procedures qualify as medically necessary, many practices still hesitate to bill medical. Whether it’s because of past denials, staff confusion, or outdated systems, the result is the same: missed revenue, frustrated patients, and a lot of extra stress you don’t need.

Let’s cut to it: billing medical doesn’t have to be a nightmare.

Sure, it requires upfront work. There are codes to learn and some new muscle memory to build. But with the right workflow—and a little help from tools like DSN Cloud—it becomes second nature. Even better, it opens up new revenue streams, helps patients afford care, and relieves some of the pressure on your front desk to “make the numbers work.”

So, here’s how to do it. Step by step. No fluff.

Why You Should Be Billing Medical

Here’s the truth: if you’re only billing dental, you’re leaving money on the table. Period.

There are countless procedures oral surgeons perform every week that qualify for medical reimbursement. Things like:

• Managing facial trauma and jaw fractures

• Excision of tumors, cysts, or lesions

• Treating TMJ dysfunction with medical implications

• Performing bone grafts for structural reconstruction

• Addressing infections that extend beyond the oral cavity

• Fabricating appliances for sleep apnea and airway support

These procedures aren’t cosmetic. They’re not elective. They’re medically necessary—and that’s the exact criteria insurance carriers look for.

Billing medical insurance for dental procedures isn’t about doing more. It’s about documenting what you’re already doing and making sure it’s coded properly. That’s the unlock.

When Medical Is Primary (and When It’s Not)

This one trips a lot of people up, so let’s slow it down.

A common mistake is submitting a claim to medical first, assuming they’ll take it—only to have it denied because the dental plan was primary.

Here’s the general rule of thumb:

• If the procedure is clearly medical in nature—trauma, pathology, systemic infection—then medical is likely primary.

• If the procedure is more tooth-specific—extractions, implants for prosthetics—then dental may come first, even if the outcome has medical implications.

In cases where you’re not sure, verify with both carriers. Some plans will coordinate benefits and pay what the other doesn’t. Others need proof that the primary rejected it before considering payment.

This is why pre-auth and eligibility checks matter. They give your staff a roadmap before any billing wheels start turning.

The Step-by-Step: Billing Medical Insurance for Dental Procedures

Let’s get into the nuts and bolts.

1. Identify a Medical Necessity

Start simple. Choose one or two procedures you routinely perform that fit the bill: biopsies, TMJ surgeries, infection management, sleep apnea appliance fittings. Build your billing muscle there before branching out.

Ask yourself: would a physician view this as medically necessary? If yes, you’re probably on solid ground.

2. Get Your Documentation Game Tight

This is where most denials happen. Medical payers aren’t lenient. You’ll need:

• Detailed clinical notes

• A clear diagnosis

• Imaging results (radiographs, CT scans, etc.)

• A letter of medical necessity (yes, even if you’re the one writing it)

• Referral notes, if applicable

You might also include photos, pathology reports, or sleep studies, depending on the case. Set up templated checklists for your team. Better yet, automate these checklists inside your practice management system.

3. Code Like a Surgeon, Not a Dentist

This is where oral surgeons often hit a wall.

Medical carriers use ICD-10 for diagnoses and CPT for procedures. Not CDT. That’s for dental only.

For example:

• ICD-10: K08.3 for retained root

• CPT: 21025 for mandibular tumor excision

If this feels foreign, you’re not alone. Consider investing in a laminated cheat sheet, code library access, or software that suggests codes based on the procedure type. DSN Cloud, for example, integrates this directly into patient charts, reducing guesswork and duplicate entries.

4. Pre-Auth (Don’t Skip It)

Insurance plans vary widely, but surgical procedures almost always require prior authorization. Without it, your cleanest claim can still get tossed.

Here’s what to do:

• Check network status (are you in-network or out?)

• Submit your pre-auth with all documentation

• Get confirmation in writing before proceeding

Bonus tip: log the pre-auth number directly in the patient record for easy retrieval.

5. Submit Your Claim

Use the CMS-1500 form for all medical claims. If you’re used to the ADA form, this one’s going to look a little different. But once your team’s done it a few times, it becomes muscle memory.

Claims should be:

• Electronic (whenever possible)

• Fully documented

• Sent through your practice management system or clearinghouse

With DSN, claims can be submitted through the same portal as your dental ones—no duplicate systems or logins needed.

6. Follow Up (Because They Won’t)

No matter how clean your claim is, assume it’s going to sit on someone’s desk. That’s just how it is.

Schedule a follow-up 10 to 14 days post-submission. Create a simple script or template for your staff to use when calling carriers.

And if the claim is denied? Don’t panic. Ask for the denial reason in writing, adjust, and resubmit. Many get paid the second time around.

7. Document the Outcome and Look for Patterns

This is how you get smarter over time.

Keep a record of:

• Which codes got reimbursed

• Which payers required more documentation

• Which procedures consistently got paid fast

This will help you forecast cash flow, train new staff, and pre-empt problems before they start.

The Most Common Pitfalls (and How to Avoid Them)

You’re not the first surgeon to think, “We billed medical and it didn’t work, so we just gave up.”

Here’s why most practices stumble:

• Coding dental when you need to be coding medical

• Submitting incomplete documentation

• Assuming dental is always primary

• Not following up on denials or delays

• Training the clinical team, but not the front desk

You need your entire team—front to back—in the loop. If your front office isn’t confident on what’s billable and what’s not, they’ll hesitate. Or worse, they’ll default to “we can’t do that.”

Make training a regular event. Bring in a billing consultant quarterly. Or even just huddle once a month to go over tricky cases. Celebrate wins when medical billing gets paid out—it reinforces the behavior.

The Right Tools Make a Difference

Manually managing this? You’ll burn out.

Software can make or break your success with billing medical insurance for dental procedures. DSN Cloud, for example, is purpose-built for oral surgeons. That means:

• Built-in code libraries and procedure mapping

• Templates for documentation and letters of necessity

• Claim tracking dashboards that flag denials early

• Support for both dental and medical billing from one interface

• A workflow that makes sense to surgical practices—not just general dentists

You don’t need software to make it possible. But it definitely makes it sustainable.

Why This Matters More Than Ever

Reimbursement isn’t what it used to be. You already know that.

Dental plans are shrinking, deductibles are growing, and patients are more hesitant than ever to move forward with treatment unless they understand their financial options.

Billing medical isn’t just about more money—it’s about patient access. It’s about easing sticker shock, improving case acceptance, and showing your patients that you’re fighting for their care in every way.

And for your practice? It’s about resilience. Medical billing opens a second stream of revenue that’s often less tapped. And in tight markets, that flexibility can make all the difference.

One Last Thing

This isn’t about becoming an expert coder or transforming your office into a billing factory.

It’s about picking your spot—finding the handful of procedures you already do that qualify for medical billing—and building from there. Maybe that means just starting with biopsies and trauma cases. Or building out a system for TMJ. You don’t need to do it all tomorrow.

But start.

Most of your peers who’ve mastered billing medical insurance for dental procedures didn’t do it overnight. They started slow, tracked results, refined their process, and eventually made it a core part of how they operate.

If you’re ready to make this easier—not perfect, but easier—reach out to DSN. We’ll show you how practices like yours are building smarter, faster systems that let them focus on patients, not paperwork.

You’re already doing the hard part. Let’s make sure you’re getting paid for it.