Maximize Dental Benefits Before They Expire: A Guide for Billers & Patients
Published by the American Dental Coders Association
Introduction: Use It or Lose It
As the calendar year progresses, now is the perfect time to initiate conversations with patients about their unused dental insurance benefits. Most dental insurance plans follow a 12-month cycle, with benefits resetting on January 1st. That means any unused portion of a patient’s annual maximum typically disappears—use it or lose it.
Dental billing professionals play a key role in maximizing both patient care and practice revenue. Understanding how to track benefits, identify eligible patients, and navigate CDT codes strategically can lead to better outcomes for everyone involved.
1. Why Mid-Year Review Matters
- Dental benefits don’t roll over.
- Their yearly maximum (usually between $1,000–$2,000) often goes unused.
- Elective or postponed procedures may be fully or partially covered.
Performing a mid-year utilization audit allows practices to:
- Fill open appointment slots with patients already in need of care.
- Complete treatment plans that were previously delayed due to cost.
- Increase insurance reimbursements before they’re forfeited.
2. How Dental Billers Can Lead the Charge
- Run Insurance Benefits Used/Remaining Reports
- Identify patients with remaining annual benefits.
- Find incomplete treatment plans.
- Check for patients overdue for preventive care.
- Prioritize Patients with Unused Coverage
- Sort by high remaining balances and previously declined treatment.
- Coordinate with Front Desk & Clinicians
- Share findings and schedule meetings to plan outreach.
- Flag charts with insurance utilization notes.
3. Educate Patients Early (and Often)
- Email or Text Campaign
“Your dental insurance benefits reset in January. Don’t let unused benefits go to waste—schedule today!”
- Use Printouts or Portals
- Provide personalized estimates and procedure recommendations.
- Offer payment options for any balance not covered.
- Staff Scripts
“Mrs. Smith, you have $850 left in benefits this year. If you want to move forward with that crown, your insurance will likely cover most of it.”
4. High-Yield Procedures to Code Before December
- Preventive
- D0120 – Periodic oral evaluation
- D1110 – Prophylaxis-adult
- D1206 – Fluoride varnish
- D0150 – Comprehensive evaluation
- Periodontal & Restorative
- D4341 – SRP (4+ teeth per quadrant)
- D4342 – SRP (1–3 teeth per quadrant)
- D2391 – Resin-based composite
- D2740 – Crown-porcelain/ceramic
- Major Procedures
- D2950 – Core buildup
- D2790 – Full cast high noble metal crown
- D6010 – Implant placement
- Adjunctive Services
- D9222 – Deep sedation
- D9230 – Nitrous oxide
5. Common Insurance Verification Mistakes
- Assuming coverage without verification.
- Overlooking frequency limitations and exclusions.
- Forgetting to document or submit pre-authorizations.
Tips:
- Use digital tools or call directly.
- Verify max remaining, deductible, downgrades, and exclusions.
- Attach supporting documentation (x-rays, clinical notes).
6. Elective Treatment Opportunities
- Cosmetic procedures (veneers, whitening).
- Occlusal guards (D9944, D9946).
- Implant-supported restorations or crown placement.
Patients are more likely to move forward when they know:
- They’re using funds that would otherwise expire.
- Deductibles reset in January.
- Flexible financing is available.
7. Sample Outreach Strategy
| Week | Action Item |
|---|---|
| Week 1 | Pull benefit usage reports |
| Week 2 | Send reminder campaign |
| Week 3 | Call patients with high-dollar cases |
| Week 4 | Fill open slots and recall no-shows |
“Don’t leave money on the table—book your appointment before the holiday rush.”
8. Why This Matters for Your Practice
- Increase Q3 and Q4 production.
- More completed treatment plans.
- Fewer cancellations due to cost.
- Improved patient trust and loyalty.
9. Continue Your Training with ADCA
If you want to master insurance coordination, coding, and claims processing, enroll in our 100% online certifications at the American Dental Coders Association (ADCA):
Conclusion: Take Action Today
Don’t wait until the holidays to notify patients about their benefits. By mid-year, many insurance policies are halfway to expiring, and unused dollars are up for grabs.
With a strategic focus on reporting, communication, and proper CDT coding, dental billing professionals can help patients get the care they need while keeping your practice productive and profitable.