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Dental billing reference

How dental plans usually pay for each kind of service, why claims come back unpaid, and what to check before you quote the patient. For front desks, insurance coordinators and billers. 17 service guides and 47 billing terms.

Updated November 11, 2026

47 terms, A to Z Dental insurance billing glossary Alternate benefit, nonduplication, the birthday rule, frequency limits and more, in plain words.

Preventive and diagnostic

Usually paid in full, without the deductible. The surprises are frequency and age limits.

Exams How plans usually pay for periodic, comprehensive and problem-focused exams, how often, and why an exam claim comes back unpaid. Cleanings Why plans usually pay two cleanings a year in full, how the six-month rule catches people out, and when a cleaning becomes perio maintenance. X-rays How often plans usually pay for bitewings and full-mouth or panoramic X-rays, and why X-rays matter for getting other claims paid. Fluoride Why fluoride is usually preventive, the age limits many plans put on it, and what to tell an adult patient whose plan won't pay. Sealants The age limits, tooth rules and replacement intervals that decide whether a plan pays for sealants.

Basic

Often 80% after the deductible. Watch for downgrades and documentation.

Fillings How plans usually pay fillings, why a back-tooth white filling is often paid at the silver rate, and how to quote the difference. Root canals Why a root canal is basic on most plans and major on some, what usually comes with it on the claim, and what to check first. Extractions How plans usually pay simple and surgical extractions, why the records decide which one is paid, and what to check before quoting. Deep cleaning (scaling and root planing) Why deep cleaning claims are denied more than most, the pocket depths and charting insurers ask for, and how plans count quadrants. Perio maintenance How plans usually pay maintenance visits after gum treatment, how often, and how they count against cleanings.

Major

Often 50%, waiting periods, and the yearly maximum runs out fast.

Crowns How plans usually pay crowns and buildups, the X-rays and notes insurers want, how often a crown is replaced, and why crown claims get denied. Bridges How plans usually pay bridges, the missing tooth clause that can rule one out, and the replacement interval. Implants Whether plans usually pay for implants, the exclusions and missing tooth rules to check, and how the yearly maximum limits what's paid. Dentures How plans usually pay full and partial dentures, the replacement interval, and the missing tooth rule.

Plans differ most

Covered on some plans, excluded on others. Check before quoting.

Emergency visits How a problem-focused exam and treatment to relieve pain are usually paid, and the same-day rules that can leave one of them unpaid. Night guards Why night guards are often limited or excluded, what plans that do pay usually want, and how to quote one. Orthodontics How orthodontic benefits usually work: a separate lifetime maximum, age limits, and payments spread over the treatment.

Free tools

Next eligible date checker When the plan pays for the next cleaning, exam or X-ray under its frequency limit. Secondary insurance calculator What the second plan pays, under standard coordination and nonduplication. Patient portion calculator Coverage, deductible and yearly maximum in; insurance and patient share out, line by line.

Common procedure codes

The 42 codes front desks bill most, from the periodic exam to the night guard, each with a page on how plans usually pay it, its usual limits and why it gets denied. The descriptions are our own; the official code set is the ADA's.

Common dental procedure codes

CDT is a registered trademark of the American Dental Association. Tabruns is not affiliated with or endorsed by the ADA. The descriptions here are our own plain-English summaries, not the ADA's official wording; use your current CDT manual or practice software for the official code set.

Working out what the patient owes

Get the patient's share in dollars, from the benefits page

Every guide here ends in the same question: what will this patient pay? Tabruns reads the coverage, deductible, yearly maximum, waiting periods and frequency limits from the insurer's portal and works out what the patient owes. Patient details stay on the office computer.

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