If you’ve ever dealt with insurance claims in healthcare, you know billing can feel like navigating a maze - especially when it comes to dental billing versus medical billing.
At first glance, they might seem similar, but dig a little deeper, and the differences become clear.
For dental and healthcare providers, understanding the difference between medical and dental billing can be the key to fewer denials and faster reimbursements.
At Wisdom, we help practices cut through the complexity and get clarity on what actually matters when it comes to billing.
In this article, we break down the real distinctions between dental billing vs medical billing, so your team can handle both with confidence—and get paid what you’re owed.
What Is Dental Billing?
Dental billing is the process of submitting, managing, and tracking claims for dental services to insurance companies or patients for reimbursement.
It involves using Current Dental Terminology (CDT) codes—a standardized set of codes maintained by the American Dental Association (ADA) - to describe procedures like cleanings, fillings, root canals, and X-rays.
- Patient Visit & Treatment – A dentist performs a procedure (e.g., a crown or extraction).
- Code Assignment – The dental team assigns the correct CDT code (e.g., D2740 for a porcelain crown).
- Claim Submission – The claim is sent to the patient’s dental insurance, often electronically via clearinghouses like DentalXChange or EDI systems.
- Insurance review – The insurer reviews the claim, checks coverage, and approves or denies payment.
- Patient Billing – If the insurance doesn’t cover the full cost, the patient receives a statement for the remaining balance.
Getting dental billing right helps your practice receive payments on time, stay within the rules, and build trust with your patients.
If you’re looking for more insights on mastering dental billing, our Exclusive Guide to Dental Billing Secrets is the perfect resource.
What Is Medical Billing?
Medical billing is the process healthcare providers use to get paid for their services.
When a doctor treats a patient, the details of that visit—like diagnoses, tests, or procedures—are translated into standardized codes.
These codes are then sent to insurance companies to request payment.
How Medical Billing Works (Step by Step)
- Patient Visit – A doctor examines a patient and provides treatment.
- Coding – A medical coder assigns specific CPT (procedures) and ICD-10 (diagnoses) codes to describe the visit.
- Claim Submission – The billing team sends the claim to the patient’s insurance company.
- Insurance Review – The insurer checks coverage and approves or denies payment.
- Patient Responsibility – If the insurance doesn’t cover the full cost, the patient gets a bill for the remaining balance.
Medical billing follows strict rules for payment, and these rules can change depending on the insurance company or government program.
Note: Wisdom specializes exclusively in dental billing services and does not offer medical billing solutions.
Dental Billing vs Medical Billing - What Is The Difference?
While both dental and medical billing involve submitting claims for healthcare services, they operate under completely different systems.
Here’s a straightforward breakdown of how they differ:
1. Coding Systems
Dental Billing → Uses CDT (Current Dental Terminology) codes (e.g., D1110 for a cleaning).
Medical Billing → Uses CPT (procedures) and ICD-10 (diagnoses) codes (e.g., 99213 for an office visit).
2. Insurance Coverage Rules
Dental Insurance → Typically has annual maximums (e.g., $1,500/year) and focuses on preventive care.
Medical Insurance → Uses deductibles, copays, and coinsurance, with broader coverage for illnesses and injuries.
3. Claim Submission & Processing
Dental Claims → Often submitted through dental-specific clearinghouses (e.g., DentalXChange).
Medical Claims → Usually processed through medical billing software (e.g., Epic, Cerner).
4. Regulatory Compliance
Medical Billing must comply with:
- HIPAA for patient privacy
- False Claims Act to prevent fraud
- Stark Law against physician self-referral
Dental Billing follows:
- State dental board regulation
- ADA guidelines
- HIPAA for patient data protection
5. Scope of coverage
Dental billing focuses on procedures related to oral health and dental care, while medical billing handles surgeries, diagnostic tests, and treatments for a wide range of medical conditions.
6. Where They Overlap
Some procedures (e.g., TMJ treatment, sleep apnea devices, or oral surgery) can be billed to medical insurance - but only if coded correctly.
Is Dental Billing the Same as Medical Billing?
As we mentioned above, dental billing is not the same as medical billing.
While both involve submitting claims to insurance companies for services provided, they follow different rules, use different codes, and handle coverage in unique ways.
One big difference is insurance coverage. Dental insurance usually covers fewer services, focusing mainly on routine dental care. Medical insurance covers a wider range of health treatments.
Sometimes medical insurance will pay for certain dental procedures—but only when they’re linked to a medical condition, such as dental work done in a hospital, oral surgery after an injury, or treatment for birth defects.
In these cases, the healthcare provider can bill the medical insurance, and the insurance will cover the costs based on that policy.
Want to take a closer look at common billing mistakes and how to fix them?
Download our free resource: 5 Dental Revenue Cycle Mistakes to Stop Now.
What Is The Major Difference Between Medical and Dental Claims?
The biggest difference comes down to what’s being billed and how:
Medical Claims
- Cover general health (surgeries, illnesses, injuries)
- Use CPT (procedures) and ICD-10 (diagnoses) codes
- Follow strict rules like HIPAA
- Paid by health insurance (Medicare, private insurers)
Dental Claims
- Only cover oral health (cleanings, fillings, crowns)
- Use CDT codes (specific to dentistry)
- Often have low annual limits (e.g., $1,500/year)
- Paid by dental insurance (Delta Dental, MetLife)
The Gray Area
Some procedures (like TMJ treatment or oral surgery) can sometimes be billed to medical insurance if they’re medically necessary.
Why This is Important
Using the wrong system = denied claims
Medical billing handles bigger costs, while dental focuses on prevention.
Is a Dental Bill Considered a Medical Bill?
No, a dental bill isn’t treated the same as a medical bill. Even though both involve health-related care, they go through different systems.
Insurance companies don’t combine them, and patients often need separate plans for dental and medical coverage.
If you receive treatment at a dentist’s office - even for something that feels “medical,” like jaw pain - it’s usually billed separately through dental insurance.
Only in special cases, like surgery for an accident or a medical condition, can dental procedures be billed through medical insurance.
Bottom line: A dental bill stands on its own - it’s not processed or reimbursed the same way as a medical bill.
Medical vs Dental Billing Codes: What’s the Difference?
While medical and dental billing both rely on standardized codes to submit claims, the way those codes are used — and what they’re designed to track — is very different.
Medical billing codes (like CPT and ICD-10) are structured to reflect a patient’s full clinical journey, including diagnostics, procedures, and follow-up care.
They’re often used together to justify medical necessity and determine how a service is reimbursed based on complexity, time, or severity.
Dental billing codes (CDT codes), on the other hand, are procedure-specific and much more focused.
A CDT code typically represents a single treatment — like a crown or cleaning — without requiring detailed diagnostic data to back it up.
This makes dental claims simpler in structure but more limited in scope.
Medical billing codes are built for complexity and medical justification. Dental codes are built for clarity and speed. If a dental office wants to submit a medical claim (e.g., for oral surgery), knowing how to properly align CDT with CPT/ICD is essential to avoid denials.
Medical Billing for Dental Procedures
Can Dental Offices Ever Bill Through Medical Insurance?
Yes — in certain cases, dental offices can submit claims to medical insurance instead of (or in addition to) dental insurance.
But this only applies when the procedure is medically necessary and clearly connected to a patient’s overall health — not just their teeth.
Which Dental Procedures Might Qualify for Medical Billing?
While most dental treatments are billed through dental insurance, some services fall into a “medical” category.
Here are a few examples:
Oral Surgery After Trauma
If a patient suffers an injury (like a broken jaw or facial fracture), the treatment is usually considered medically necessary.
In these cases, oral surgery — even when done by a dentist — may be billed to medical insurance.
Biopsies and Oral Pathology
When a dentist performs a biopsy to check for oral cancer or suspicious lesions, the procedure supports a medical diagnosis.
That makes it eligible for medical billing under diagnostic and surgical codes.
TMJ Disorder Treatments
TMJ (Temporomandibular Joint) disorders can cause chronic pain, headaches, and difficulty eating or speaking.
Medical insurance may cover diagnostic imaging (like MRIs), splints, or even surgical treatment — all billable under medical coding.
Sleep Apnea Appliances
If a dentist provides an oral appliance to treat obstructive sleep apnea (OSA), it’s often covered under a patient’s medical benefits — especially when prescribed by a physician or tied to a sleep study.
Bone Grafts and Dental Implants (in Specific Cases)
While typically considered dental, these procedures may be covered by medical insurance if they’re part of a larger medical issue — like reconstructive surgery after cancer or trauma.
To successfully bill these procedures medically, the documentation must clearly show why the treatment is medically necessary — not just dental in nature. Correct medical codes, physician referrals, and proof of diagnosis are often required.
Common Dental Billing Challenges and How to Overcome Them
Dental billing can be complex, and even small errors can lead to claim denials, delayed payments, or lost revenue.
Understanding the common challenges helps dental practices avoid costly mistakes and improve their billing efficiency.
Incorrect or Missing CDT Codes
Using outdated or incorrect Current Dental Terminology (CDT) codes is one of the top reasons claims get denied.
Dental codes are updated annually, so staying current is essential. Always double-check codes before submitting claims to prevent delays.
Incomplete Patient Insurance Information
Missing or inaccurate patient insurance details can cause claim rejections.
Collect thorough insurance information during patient intake and verify coverage before treatment to reduce denials.
Lack of Documentation and Medical Necessity
For procedures that might qualify for medical billing (like oral surgery or TMJ treatments), proper documentation proving medical necessity is crucial.
Without this, insurance companies may reject claims or reduce reimbursements.
Failure to Collect Copays and Deductibles Upfront
Delaying copay and deductible collection can increase outstanding patient balances.
Collecting these payments at the time of service improves cash flow and reduces billing follow-ups.
Limited Follow-Up on Denied or Delayed Claims
Claims may be denied for various reasons, but timely and persistent follow-up can turn a denial into an approval.
Establish a system to track claims status and appeal denials quickly.
Best Practices for Efficient Dental Billing
Implementing these best practices will help your dental practice maximize reimbursements and minimize administrative burdens:
- Use Reliable Dental Billing Software: Choose software that supports CDT coding updates and integrates with dental insurance clearinghouses.
- Train Your Staff Regularly: Keep your billing team informed about coding changes, insurance policies, and claim submission rules.
- Verify Insurance Before Treatment: Confirm patient benefits and eligibility to avoid surprises later.
- Maintain Clear Communication with Patients: Explain their financial responsibilities upfront to build trust and improve collection rates.
- Outsource to Dental Billing Experts When Needed: Partnering with specialized dental billing companies like Wisdom can optimize your revenue cycle management and reduce errors.
Why Addressing These Challenges Matters for Your Practice
By proactively tackling these common billing issues, your dental practice will:
- Reduce claim denials and rejections
- Speed up reimbursements and cash flow
- Lower administrative workload and costs
- Improve patient satisfaction through transparent billing
- Stay compliant with changing industry regulations
Why Specialized Dental RCM Is Critical for Practice Success
Dental billing is not just a smaller version of medical billing — it’s a distinct process with its own codes, rules, and reimbursement limitations.
That’s why specialized dental revenue cycle management (RCM) * is so important.
Here’s why:
1. Accurate Dental Coding (CDT)
Dental RCM experts understand CDT codes inside and out — ensuring every claim is submitted with the correct code and supporting documentation to avoid denials.
2. Dental-Specific Insurance Rules
Unlike medical plans, dental insurance comes with strict annual maximums, frequency limitations, and procedure exclusions. A specialized dental billing team can navigate these nuances to optimize collections.
3. Faster Claims Processing & Fewer Errors
With dental-specific clearinghouses and systems in place, specialized RCM teams speed up claim submissions, reduce rejections, and minimize rework.
4. Improved Patient Experience
When billing is transparent, accurate, and timely, your patients are less likely to be confused or frustrated by unexpected charges or delays — leading to better satisfaction and loyalty.
5. Revenue Growth Without the Administrative Burden
Outsourcing to a team that focuses only on dental RCM frees up your front office to focus on scheduling, care, and patient relationships — not chasing claims.
*Note: Dental Revenue Cycle Management (RCM) encompasses the full journey of a dental claim, from insurance verification and coding to submission, adjudication, and payment collection. Unlike general RCM, dental RCM requires a precise understanding of CDT codes, benefit limitations, and dental clearinghouses.
Conclusion: How Wisdom Helps Dental Teams Succeed with Billing
At Wisdom, we specialize in one thing — dental billing done right.
Our US-based dental billing experts know what it takes to get claims paid — from applying the right CDT codes to recognizing when a procedure might require medical documentation, even if it’s billed dentally.
We help dental practices reduce denials, accelerate payments, and stay compliant — without pulling staff away from patient care.
If your team is spending too much time fixing billing issues or chasing down reimbursements, Wisdom can give you the support and clarity you need to get paid faster and focus on what matters most: caring for your patients.
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