Orthodontic billing has its own set of rules, timelines, and challenges. Because claims stretch over months (or even years), having clear, consistent guidelines protects your cash flow and saves your team from unnecessary insurance headaches.
Here are the top 7 billing guidelines every orthodontic practice should establish:
1. Verify Benefits Clearly and Completely
Accurate verification is the foundation of clean billing. Always confirm:
- Lifetime orthodontic maximum
- Remaining benefits
- Age limits or waiting periods
- Coverage percentage or dollar amount
- In- vs out-of-network differences
- Coordination of Benefits (when two plans exist)
Clear verification = clear expectations for both your practice and your patients.
2. Use the Correct Orthodontic Codes
Orthodontic billing is code-specific, and using the wrong code creates delays and denials. Your biller should confidently understand when and how to use:
- D8020/D8030/D8040 (limited ortho treatment codes)
- D8070/D8080/D8090 (comprehensive ortho treatment codes)
- D8670 (periodic visits)
- D8680 (retention)
Accurate coding keeps claims moving without interruptions.
3. Submit Claims With All Required Documentation
Most orthodontic carriers require additional documentation. To prevent delays:
- Add a clear treatment plan (start date, total fee, length of treatment)
- Ensure the narrative is simple and accurate
- Double-check that provider info matches what the payer has on file
Missing documentation is one of the most common causes of slow payments—this solves that.
4. Track Initial & Monthly Payments Consistently
Because orthodontic benefits are paid over time, tracking is critical. Your system should clearly show:
- Initial payment received
- Expected monthly or quarterly payments
- Any unexpected stoppages
- Claims needing follow-up
- COB updates that impact payment flow
If you’re not tracking every step, money will get missed.
5. Follow Up on Unpaid Claims Routinely
Set a strict follow-up schedule for all outstanding claims:
- Check aging every 14–21 days
- Follow up immediately when documentation is missing
- File appeals promptly when needed
Consistent follow-up prevents aging from piling up and protects your revenue.
6. Keep Ledgers Clean and Posting Accurate
Your biller should post with precision—every time. That includes:
- Matching EOBs to contracted fees
- Applying adjustments correctly
- Separating initial payments from ongoing payments
- Watching for downgrades or discrepancies
Clean ledgers make reporting, collections, and patient communication simpler and more accurate.
7. Invest in Training and Oversight
Orthodontic billing changes often. Keeping your biller supported is key.
- Ongoing training like Confused 2 Confident: Insurance Masterclass helps billers stay confident, fast, and accurate
- Oversight programs like Accountability Takes TWO add another layer of support, guidance, and monitoring
When your biller has the right education and a second set of eyes, your entire practice benefits.
Final Thoughts
These seven guidelines create a strong billing foundation for any orthodontic practice. With clear processes, accurate posting, consistent follow-up, and proper training, your practice experiences fewer delays, cleaner claims, and a much smoother insurance workflow.