Dental Billing in 2026: The CDT Codes Practices Still Get Wrong

Dental billing has a peculiar problem: it looks simpler than medical billing, so it gets less attention. Then the denials arrive.

Here are the five mistakes we find in nearly every dental practice audit.

1. SRP (D4341 / D4342) documentation gaps

Scaling and root planing is the most-denied dental procedure we see. The codes themselves are straightforward — D4341 for four or more teeth per quadrant, D4342 for one to three. The problem is documentation.

Payers want periodontal charting with pocket depths, radiographic evidence of bone loss, and a diagnosis. If the chart just says "SRP UR quadrant," expect a denial.

2. Missing the medical crossover

This is where real money is left on the table. A number of procedures dental practices bill to dental insurance are legitimately billable to medical:

• Surgical extractions with medical necessity
• Sleep apnea appliances
• TMJ treatment
• Biopsies and lesion removal
• Trauma-related restoration

Dental benefits cap out fast. Medical benefits usually don't. Practices that never cross-bill are capping their own revenue.

3. Frequency limitations ignored

Prophylaxis (D1110), bitewings, exams — all have frequency limits that vary by plan. Billing a cleaning at month 5 when the plan allows one every 6 months produces an automatic denial, and often an unhappy patient who now owes for it.

This is a pure verification failure and 100% preventable.

4. Downgrades not anticipated

Many plans downgrade a composite filling (D2391-D2394) to the amalgam rate. The claim isn't denied — it's just paid less, and the patient is surprised by the balance.

The fix is front-end: verify the downgrade provision and inform the patient before the procedure.

5. Coordination of benefits handled badly

When a patient has two dental plans, the order matters and the secondary claim needs the primary's EOB. Practices that submit secondary claims without the EOB, or in the wrong order, generate denials that then sit in AR for months.