How to write a dental invoice

Five papers that look alike

A dental visit can generate five documents, and most billing calls happen because the patient is holding one and thinks it is another. The claim goes to the plan on the ADA Dental Claim Form, which the ADA describes as a common format for reporting dental services to a patient's dental benefit plan; the current version is the 2024 form. The plan answers the patient with an explanation of benefits. Then the practice sends what this page is mostly about: the statement that says what the patient owes.

Delta Dental of Iowa puts the explanation of benefits plainly: it is not a bill, but an explanation of what was performed and what the plan covered. Print a sentence on your statement that says the same thing. It is the cheapest call-prevention you will ever write.

Codes on the statement, and who owns them

Each line on a dental bill carries a procedure code from the Code on Dental Procedures and Nomenclature, known as CDT. The ADA states that it is the exclusive copyright owner of CDT, and its ADA licensing page says commercial use, including published materials, needs a license from the ADA. The licensing page speaks to products and services and does not address an office's own claims or statements; the ADA code FAQ says the CDT Code is a HIPAA standard for electronic dental claims and that the code reported should be from the version in effect on the date of service. In practice the license sits with the software: Open Dental's CDT page says its ADA license lets it include the CDT codes for distribution in the United States, and that every US customer returns a compliance form listing its end-user sites. We found no ADA page that speaks to printing codes on an office's own patient statements. That shapes how a practice should write a statement. Use the code your billing software assigns, and beside it a plain description in your own words that a patient can understand. Do not copy the ADA's descriptors into marketing, forms you sell or public pages.

The four codes in the example below were checked against a public state program list, the Montana DPHHS code list, which lists D0120 as the routine exam for an existing patient, D0274 as the four-image bitewing set, D1110 as an adult cleaning and D2391 as a one-surface tooth-colored filling on a back tooth. Those are our paraphrases, not the ADA wording. Codes change between CDT editions, so check yours against the current set your software carries. For fillings and crowns, add the tooth number and surfaces, since that is what lets a patient match the statement to the explanation of benefits.

Patient statement example, filled in

A routine recall visit with one filling, after the plan has paid. Fees are samples; your fee schedule and contracted fees decide the real ones.

Fees of $490, less a $45 contracted adjustment and a $330 plan payment, leave $115 for the patient. Each deduction has its own line, so the patient can see why the number is not $490 and can find the same figures on the plan's explanation of benefits.

Adjustments, estimates and the second statement

The middle lines are where statements go wrong. A contracted adjustment is not a discount and should not be labeled as one; call it what the plan calls it. A plan payment should show its date. And any figure shown before the plan has paid is an estimate, so label it as one, name what it assumes and promise a corrected statement if the plan pays differently. A patient told $60 who then receives a bill for $140 remembers the surprise long after the reason.

Payments taken at the chair belong on the statement as a dated credit line. Leave one off and the practice bills a patient for money already handed over, which is the fastest way to lose a family of patients. Treatment that spans visits, such as a crown prepared one day and seated weeks later, should show each visit's date on its own lines; how your plan contracts treat the date of a multi-visit procedure is a question for your biller, not the statement layout.

Out-of-network patients and the superbill

When the practice is out of network, the money flows differently. The ADA News column on out-of-network billing says the patient remains responsible for the office's full fee, that the patient's benefits relationship is with the payer and not the dentist, and that an office may still submit claims as a courtesy. A patient can also sign an assignment of benefits that sends the plan's payment straight to the dentist; the ADA notes that it applies only to the direction of payment.

If the patient pays and files alone, they need an itemized receipt with codes, dates, fees, the treating dentist and proof of payment. Many offices call it a superbill. We found no official definition or standard format for a superbill, only practice software vendors' descriptions, so the useful test is whether the patient's plan can process a claim from it.

Fees of $167, paid in full at the visit, so the balance is zero. The footer tells the patient the practice is not filing, which settles who does what.

Self-pay patients and the good faith estimate

Patients who pay without insurance add a step before the invoice. ADA News reported in 2022 that good faith estimates are required for uninsured or self-pay patients, that providers have three business days to give one in writing after a request, and that it must include a disclaimer that the actual items, services or charges may differ. CMS, whose page speaks of providers and facilities without naming dentists, sets the timing by how far ahead the visit is booked: within one business day when it is booked three to nine business days out, and within three business days when it is booked ten or more days out.

The estimate then becomes a benchmark for the bill. The CMS dispute page says a patient can start a dispute when a provider charged at least $400 more than the good faith estimate, using a bill dated within the last 120 calendar days. Keep the estimate number on the final invoice, and if the treatment grew, explain the new lines and update the estimate before the work rather than after.

Collecting the balance

Catch unpaid balances at the first statement. A short reminder with the balance and a payment link outperforms a second paper bill, and a patient who can pay from the statement on a phone usually does. The late fee calculator works out what your written terms allow, but check your state rules and your plan contracts before you add any fee to a patient balance.

Before a statement goes out

• The patient and the account holder, who are not always the same person.
• A date of service on every line, and the tooth and surfaces where they apply.
• The code your software assigned, with your own plain description beside it.
• Fees first, then adjustments, then dated plan payments, then the balance.
• An estimate label on any plan figure that has not been paid yet.
• A sentence saying the plan's explanation of benefits is not a second bill.
• No diagnoses or treatment notes. Clinical detail stays in the chart.

This page covers billing format only. It is not medical, coding or legal advice.

Dental invoice questions

Free dental statement template

There is no dental preset in the generator. The nearest is Therapist / massage, built around sessions, so retype the lines as procedures with the date and code in each description. For a printed statement, download the blank invoice as Word, Excel or PDF and rename the title to Patient statement. A paid visit takes a receipt, which is also the starting point for an itemized receipt for insurance.

Other appointment-based practices

Tools for practice billing

For the front desk, not the chart.