Interestingly, as dental offices show charges for certain procedures, and as they bill insurance companies, an increasing number of heretofore non-reimbursable billing codes are, in fact, now being reimbursed by insurance companies. Fittingly, in these cases, the dental community, not the insurance companies, have standardized certain care procedures. And faced with ever increasing pressure to ensure patient safety and care, the insurance companies have had to capitulate and begin paying. Irrigation charges, fluoride charges, posterior composites, and even oral hygiene instruction charges are a few examples now beginning to be reimbursed by some insurances. So, another benefit to the dental community of consistently using a set standard of procedures, and in this case, showing a charge and billing for them, can be added to the reasons for establishing and adhering to a set Standard of Care for all dental situations.

For cash patients, or patients whose insurances are not currently paying for certain procedures, the dental office will use their discretion as to when, where, why, and how much, those procedures are actually charged to the patient. (Remember, they will always show on the treatment plan, with or without a fee.)

The best way to ensure that you are always adhering to your standard of care is to write out your procedures for most dental treatment opportunities in advance.

For now, don’t be concerned with fees or insurance coverages for any treatment. This will be addressed in detail later (Insurance and Billing Section). As you delineate your procedures, find the American Dental Association (ADA) procedural code for them. These codes will be important because: a) the Dental Association recognizes them as an approved course of care, and b) you will utilize the Codes to determine financial reimbursements.

Codes are constantly changing. Insurance companies manipulate the codes in their individual contracts, all for the purpose of maximizing their profitability, of course. The following codes are in effect as of 2014. Again, do not be overly concerned with the insurance companies inclusion or exclusion of certain codes at this time. There will be a detailed explanation of that topic under the Dentistry Simplified section: Insurance Billing Chapter of Insurance Section. Refer to: Samples of Procedures Organized into Standards of Care. The applicable ADA code is shown next to it. Each dentist may have particular procedures they add or subtract from the examples shown. However, as you learn in the Insurance and Billing Section, there are dental practices right now performing, charging, billing, collecting, and perhaps setting the next level of Standards of Care by using just these very procedures and codes. And, they are being financially rewarded for it.

The following Standards of Care are samples for frequently recommended dental procedures. As stated, you and your team must agree on what the Standards will be for your practice. Once determined, you will always perform every procedure for every patient who requires that particular treatment. Always perform, describe, and list every one of the procedures within the treatment, whether you charge for it or not.