Dental Billing Denials: How To Fix Them Fast [2025]

According to the American Dental Association, nearly 1 in 5 dental insurance claims are initially denied, and practices lose an average of 4% to 8% of revenue annually due to preventable billing errors. 

Every denied claim delays reimbursement, increases administrative workload, and frustrates both patients and staff. In 2025, with tighter insurance policies and more complex coding requirements, understanding why dental claims get denied—and how to prevent it—is more critical than ever.

This guide will walk you through the most common reasons for dental billing denials, how to prevent them, and what to do when a claim is rejected.

Why Do Dental Insurance Claims Get Denied?

A denied claim means the insurance company has reviewed your submission and refused payment, either in part or in full. 

Unlike a rejected claim (which has errors and wasn’t processed), a denial means the claim was processed but didn’t meet the criteria for payment.

Here are the most common reasons why dental claims get denied:

1. Missing or Incorrect Patient Information

Simple errors like a misspelled name, incorrect date of birth, or missing insurance ID number can cause instant denials. Many systems now auto-populate this information, but that doesn’t mean it’s always accurate.

2. Coverage Limitations or Frequency Issues

Insurance plans often limit how often procedures like FMX (D0210), cleanings, or fluoride treatments can be billed. If your office submits these services too soon without justification, the claim will likely be denied.

3. Lack of Medical Necessity

Many payers require clinical documentation or X-ray evidence to support treatment, especially for scaling and root planing, crowns, or multiple restorations. Without clear notes showing why the treatment was needed, the claim may be denied.

4. Incorrect or Misused CDT Codes

Coding errors are another major reason for denials. This can include using outdated CDT codes, billing two codes that aren’t billable on the same day, or unbundling procedures that should be grouped together.

5. Coordination of Benefits (COB) Issues

If the patient has dual insurance and the primary vs. secondary payer isn’t clearly defined, the claim can be held or denied until COB is clarified.

6. Missing Attachments or X-rays

Claims for crowns, scaling, and certain oral surgeries often require clinical notes, periodontal charts, or radiographs. Submitting the claim without the correct attachments leads to unnecessary back-and-forth.

How To Prevent Dental Billing Denials?

Here are the top 5 pro tips that can help get ahead of them. 

1. Train Your Billing Staff on CDT Updates

Every year, CDT codes change. Make sure your team is up to date with the latest codes, cross-coding best practices, and payer-specific requirements.

2. Use Claim Templates with Built-in Checks

Leverage dental billing software or clearinghouses that flag missing attachments or code mismatches before submission. These tools reduce human error dramatically.

3. Document Medical Necessity Clearly

For procedures like scaling and root planing (D4341), always include perio charting, X-rays, and detailed clinical notes. Explain symptoms, diagnosis, and rationale for treatment.

4. Use Real-Time Eligibility Tools

Many practice management systems offer real-time eligibility checks. Use them to confirm plan details, deductibles, and coverage limits at every visit.

5. Always Verify Insurance Before Treatment

Always confirm coverage, frequency limits, exclusions, and patient eligibility before submitting a claim. Use benefit breakdown forms and call payers directly if needed.

What Can You Do When a Claim Is Denied?

Even with the best systems in place, denials still happen. Here’s a step-by-step process to appeal and fix denied dental claims:

Read the denial code and notes from the payer. This will tell you exactly why the claim was denied – missing information, not medically necessary, COB conflict, etc.

1. If the claim was rejected due to a clerical error (like a wrong code or missing ID), correct the issue and resubmit it as a new claim.
2. For true denials, draft an appeal letter and attach supporting documents: clinical notes, X-rays, perio charts, and anything else that validates medical necessity. Submit within the payer’s deadline.
3. Set reminders to follow up with insurance companies within 10–15 business days after resubmission. Use a spreadsheet or practice management system to track appeals.
4. Use denials as learning opportunities. Hold monthly billing audits and team reviews to prevent repeat issues.

Partner with Experts to Reduce Denials Today

If you’re struggling to keep up with rejections and appeals, you’re not alone. Many dental practices lose thousands of dollars each month to preventable denials.

That’s where Zeroed-In Dental Solutions can help. Led by billing expert Linda Kane, Zeroed-In provides:

• Clean claim submission
• Insurance verification and benefit breakdowns
• Appeal and denial management
• Software support for Dentrix, Open Dental, Curve, Eaglesoft, and more

Zeroed-In works with dental practices to streamline operations, reduce denials, and get you paid faster. Tired of writing appeal letters? Chat with Linda today and stop letting denials slow you down!