How This Dental Crown Case Was Paid By Medical Insurance

In this example Imagn Billing case you will see how a dental office in Florida successfully billed for dental crowns. Our Imagn Billing team processed this claim on 12/4/2020 to Tricare insurance and it was paid on 1/22/2021.

The 56-year-old female patient presented for additional treatment following chemotherapy and radiation.  She was referred by the Mayo Clinic and pre-authorization was obtained.   

Proving Medical Necessity 

As noted in the provider’s SOAP note below: 

  • Squamous cell carcinoma of tongue
  • Chemo & radiation 12/13/07
  • Medical induced Xerostomia
  • Noted necessity for crowns, removal of caries lesions, srp


-Thursday, December 03, 2020 at 12:10:05 PM

Pt presents for Crown: # 29,30

RMH. No changes



Age of Previous Crown: initial placement


Dx: previous treated RCT

Tx: crowns #29,30


Treatment was reviewed with the patient.

Verbal and written consent obtained.


Topical anesthetic: benzocaine

Local anesthetic: Negative aspiration. infiltration with 1.8cc 2% lidocaine 1:100;000epi

Isolation: cotton rolls

Decay: moderate

Decay removed and tooth prepped for porcelain crown.

Buildup done:

HS GL Desensitizer, Prime and Bond Elect, Fluorocore 2

Prep finalized. Retraction cord packed with viscostat for 2 minutes. Retraction cord


Impression taken with Itero scanner.

Provisional fabricated with TempSpan A2 and cemented using HS Temp Cement.

Excess cement removed. Flossed.


Case sent to Glidewell.

Please fabricate full contour zirconium crown.

Shade: 2M2


Patient tolerated procedure well.

POIG, including warnings about postop sensitivity (hot/cold/pressure sensitivity and

possibility of endo). Explained to patient to be careful when flossing in the area around

the temporary and to avoid sticky foods. In the event the provisional comes out, pt

advised to call the office.


NV: Deliver crown/ IMP for partial (cu-sil)

Dr. John/ Pratt

Billing Medical Insurance

The practice collected all required documentation and clinical SOAP notes. After completing the verification of benefits(link), it was determined that coverage was available after co-insurance is satisfied.  Pre-Authorization was obtained with an allowance of 6 visits to be completed by 4/30/2021.

Dental Comparison 

Without medical insurance contribution, the practice would be writing off approximately 38% and using the annual $1500.00 maximum.  Medical insurance saved the patient and the practice approximately $2000, whereas dental insurance would have been exhausted. If there are any other issues, the provider has the authorization to move forward until 4/30/21

3 thoughts on “How This Dental Crown Case Was Paid By Medical Insurance”

  1. Barbara Jacobsen

    Laurie, thank you for this article. I am attempting to search for resources for how to successfully code her medical insurance for my 23 year old granddaughter’s extensive dental needs. We have received a treatment plan to have all of her teeth crowned. The total cost is 47460. This treatment plan appears to be the consensus of three dentists. Emily had a bone marrow transplant in 2015. She was hospitalized for 16 months in three separate hospitals. During her hospitalization she had many complications, including the need for open heart surgery, acute respiratory distress and a week on ECMO. When she came home on a ventilator and 52 meds per day. All her teeth had cavities. We dealt with that, cost was 10,000. But the teeth under her repairs continued to deteriorate, due in part to acid reflux. Emily needs a hip replacement and due to Covid has waited a year for surgery. But she can not have surgery until her dental issues are addressed due to ongoing infection. The prosthodontist we have selected has no knowledge of how to code for dental work in Emily’s situation. So I am looking for information, and perhaps a person willing to consult with his office. Given the past 6 years, our financial situation does not allow us to meet this financial challenge alone. Again, thanks for the information.

    1. Hello Ms. Jacobsen, that is horrible! My first question is what insurance does she have…HMO, PPO, EPO? The first thing I would want is a letter from her physician to correlate her medical condition with her oral cavity. From there you would need to contact her medical insurance for preauthorization of the treatment plan. Unless her prosthodontist is open to learning medical billing, you or your granddaughter would need to advocate for the benefit.

  2. Hi Laurie,

    I’m an RN who experienced an unfortunate accident while in Spain last November and was seen in the ER. I saw a dentist the next morning due to the ER not doing their due diligence and prolonged the vital teeth saving treatment I needed. I fractured 2 teeth and avulsed 1. I have been trying to get my medical insurance to pay for all dental and endodontist visits due to the nature of the injury and medical necessity. They’ve denied all claims due to “incorrect procedure codes” being used. Is there a way I can convert all of the CDT codes to CPT codes? They will accept a resubmission with CPT codes. Thanks in advance!

Leave a Comment

Your email address will not be published. Required fields are marked *

Imagn Medical Billing Service

Due to the complex nature of medical insurance billing, most dental offices are not equipped with the knowledge to properly credential national payers, submit successful claims, or handle aging and appeals. Imagn Medical Billing Service performs the proper credentialing and billing for you, which results in fewer denials and time well saved as you rely on expert help.

One-Time Credential Fee

$795/per dentist

The key to more successful payments

Our experts complete the process so you can start billing medical insurance. Each dentist billing medical insurance needs to be credentialed.

Pay Per Case

Verification of Benefit

$35 per vob

We get your patient’s insurance information so you can set proper expectations with the patient regarding the specific coverage available and any out of pocket fees. This is the most critical step in all of medical billing.

Per Authorization

$40 per auth

All procedures require pre-authorization in order for your practice to get paid. Gaining appropriate authorization can be challenging, let our experts get the job done for you.

Claim Submission

8% of successful claim

You don’t have time to sit on hold. Let us sit on hold and handle the claim submission work for you  We also handle the aging and appeals so you can focus on your practice.

Choose Your Software

Imagn Software is your one stop solution with both medical billing and dental sleep medicine capabilities with world-class support

What most dentist don’t know is that medical billing can increase your case acceptance rate and ensure your patients get the care they need.

Imagn Software

$195 /month

No contract and your satisfaction guaranteed.

Our goal is to give you the best experience. But if you are not satisfied then we will give you a full refund for your software access fee within 30 days of purchase.

Add Imagn Sleep Software

$100 /month

Our software provides everything you need

to give your patient’s the sleep care they deserve.

Patients can no longer afford to have dentists ignore the responsibility of providing care for sleep disorders. Two out of every three Americans report poor sleep; the ability to breathe well is the most important factor in determining a person’s sleep quality. 

Imagn Software Set-up Fee

$399 one-time fee

No contract and your satisfaction guaranteed.

Our goal is to give you the best experience. But if you are not satisfied then we will give you a full refund for your software access fee within 30 days of purchase.

Choose Your Monthly Devdent Support Program

In order for you to succeed, we offer a unique range of customer support solutions including coaching, online resources, implementation programming, and so much more. We keep an eye on the ever changing industry trends so you can focus on your practice

Medical Billing Support

$200 /month

The program to get and keep your staff trained.

Dental Sleep Medicine Support

$200 /month

The program to implement Dental Sleep Medicine into your practice.


$345 /month

Get both of the Medical Billing and Dental Sleep Medicine Support programs at a discount.

I am already an expert