ADA Top Claim Submission and Processing Concerns

The ADA Council on Dental Benefit Programs continually receives and addresses a variety of dental claim submission and adjudication questions from member dentists and practice staff. Here are the top concerns about dental claims as published in the ADA News. The articles included perspectives from ADA members, National Association of Dental Plan members and the Council on Dental Benefit Programs:

  1. D4341, D4342 coding for periodontal scaling and root planing (SRP) per quadrant for partial quadrant (PDF, November 2006)
  2. D4910 coding for periodontal maintenance (PDF, November 2006)
  3. D2950 core buildup, including any pins (PDF, January 2007)
  4. Pre-authorizations (PDF, January 2007)
  5. Claims processing delays (PDF, May 2007)
  6. Claims payment concerns (PDF, May 2007)
  7. Bundling and downcoding (PDF, June 2007)
  8. Least expensive alternative treatment clause (PDF, September 2007)
  9. Overpayment/refund requests (PDF, February 2008)
  10. Coordination of benefits (PDF, May 2008)
  11. Provider contract issues (PDF, July 2008)
  12. Assignment of benefits to participating dentists only (PDF, September 2008)
  13. Post-utilization review (PDF, October 2008)
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