7 Ways to Dispel the Rumors That Medical Billingfor Dentistry Doesn’t Work

If you've ever thought—or been told—that "medical billing for dentistry doesn't work," you're not alone. This rumor is so common, it's practically folklore in many dental offices. But here’s the truth: Medical billing absolutely works in dentistry—if it’s done the right way.

At PPO Profits, we’ve worked with practices across the country who’ve successfully billed and collected thousands of dollars from medical carriers for procedures once thought to be “dental-only.” So why does this myth keep circulating? Because most dental teams haven’t been taught how to do it right, or they’ve tried once without a system and given up too soon.

Let’s break down the seven biggest reasons this rumor exists—and exactly how to shut it down for good.

1. Share Real Results—Because They’re Happening Every Day

One of the most common objections we hear is: "Insurance never pays." But that’s simply

not true. What doesn’t work is submitting dental documentation for a medical claim.

When dental teams learn how to use CPT and ICD-10 codes, submit SOAP notes, write

medically justified letters, and follow medical guidelines, they get paid.

Here are a few examples from real PPO Profits cases:

• $3,200 reimbursement for surgical bone grafting and membrane placement (CPT

  21210 & 15574)

• $4,800 for IV sedation, CBCT, and trauma-related oral surgery (CPT 70486, 99152,

  99153, 41823)

• $47,000+ for an All-on-X case that included multiple implants, sedation, and CT

  imaging, billed medically due to systemic bone loss and function impairment

When you see those results, the rumor quickly loses its power. Practices that follow a

documented and medically compliant process don’t just hope to get paid—they expect it.

2. Clarify Medical Necessity—It’s the Foundation of Everything

Medical billing isn’t about proving that a patient has bad teeth—it’s about proving how their oral condition affects their overall health and function. If a patient can’t chew, swallow, speak, or breathe correctly due to bone loss, infection, or trauma, those are functional impairments—and that’s what medical carriers care about.

Conditions like:

• Diabetes-related tooth loss

• Autoimmune conditions that impact oral function

• TMJ disorders

• Severe atrophy with prosthetic difficulty

• Post-cancer or trauma reconstructions

• Congenital disorders

• Wisdom teeth removal

• Boneloss

...all have clear medical necessity. PPO Profits trains dental teams to connect the patient’s oral condition to systemic or musculoskeletal function using accurate diagnosis codes and medically framed language. Without this, even the best procedures get denied.

3. Simplify the Process With Systems That Actually Work

Many practices abandon medical billing because they say it’s “too complicated.” But in truth, it’s only complicated when you don’t have a system. A consistent, step-by-step protocol eliminates guesswork. This includes:

• Verifying medical benefits in advance

• Knowing when a preauthorization is required

• Using checklists for documentation

• Submitting SOAP notes and LOMNs with the claim

• Tracking claims and following up every 10–14 days

At PPO Profits, our in-house teams follow these systems daily, and so do the practices that attend our 2-day course. When you build consistency, the chaos disappears.

4. Use the Codes That Already Exist—Because They Do

Here’s another myth: "There aren’t medical codes for dental procedures." In reality, there are plenty of applicable CPT codes that cover common oral procedures:

• 70486: CBCT imaging

• 21210(5): Bone graft to maxilla or mandible

• 15574(6): Membranes

• 41874: Alveoplasty

• 99152(3): IV sedation

• 21085: Surgical guide

• 21089: Unlisted maxillofacial prosthetic procedure (used for hybrids and custom implant-supported devices)

• MANY, MANY MORE

Diagnosis codes like K08.22, K08.25, M26.54, and R13.19 support the reason for treatment. Most denials come from using CDT codes, or using the right CPT code but pairing it with a vague diagnosis. PPO Profits helps teams pair them correctly and tell the full story.

5. Help Patients Afford Treatment Through Their Medical Benefits

Let’s get personal for a moment: some patients can’t afford the care they desperately need. Medical billing isn’t just about boosting practice revenue—it’s about increasing access to care. Consider:

• A patient with Sjögren’s syndrome and severe dry mouth, unable to wear dentures

• A cancer survivor needing reconstruction post-radiation

• A child with a severe airway issue requiring myofunctional therapy

• A diabetic patient with end-stage boneloss

For these patients, medical benefits may be the only way treatment becomes possible. When you understand how to bill, you become their advocate—and their provider. It’s one of the most rewarding parts of what we do.

6. Join the Growing Network of Practices Who Are Already Doing This

Many doctors say, “I don’t know anyone billing medical successfully.” That’s because success stories often fly under the radar—until they’re shared. Hundreds of practices across the U.S. are actively billing and being paid by medical carriers. PPO Profits alone supports dozens of offices every week with outsourced claims and in-practice coaching. When you surround yourself with a community of providers who are doing it right—whether through our billing service or our courses—you gain support, insights, and confidence. You realize you’re not alone, and you don’t have to figure it all out by yourself.

7. Use Denials as Feedback—Not a Reason to Quit

Denials aren’t a signal that medical billing doesn’t work—they’re a signal that something in the process needs adjustment. Most denials fall into a few fixable categories:

• Diagnosis doesn’t match the CPT code

• Preauthorization was required but not submitted

• Missing documentation (e.g., no LOMN or SOAP note)

• Wrong patient class (e.g., claim submitted under dental plan instead of medical)

At PPO Profits, we train teams to recognize and correct these patterns. Appeals and resubmissions are part of the process, and with each one, your system improves. Those who succeed don’t avoid denials—they learn from them.

Ready to Make Medical Billing Work in Your Office?

You’ve now seen the truth: medical billing for dentistry does work for those who are trained, supported, and strategic.

At PPO Profits, we offer two powerful ways to help you get started:

Want to learn it in-house?

Join our 2-day Step-by-Step Medical Billing for Dentistry course

This intensive, hands-on course walks you and your team through everything you need to

successfully bill medical, from documentation and coding to real case studies, SOAP note

templates, and appeal strategies. You'll leave with a complete billing system ready to use

the next day.

Want to hand it off to the experts?

Let PPO Profits handle it for you with our full-service medical billing team.

We take care of everything—coding, claims, pre-auths, LOMNs, follow-up, and appeals—

so you can focus on patients while we focus on getting you paid.

Don’t let outdated beliefs limit what’s possible.

Let PPO Profits show you how medical billing can unlock better outcomes for your patients

and your practice.