Top Dental Billing Challenges and Solutions for 2025
Published by the American Dental Coders Association
Dental billing and coding is rapidly evolving. As we step into 2025, practices are facing a new wave of challenges, from increased claim denials and tighter documentation requirements to staffing shortages and growing demand for cross coding. The good news? Each challenge presents an opportunity for growth and efficiency.
In this post, we’ll outline the top dental billing challenges for 2025 and provide practical, proven solutions. Whether you’re a billing coordinator, office manager, or dental professional, this guide will help you stay ahead in a changing landscape.
To take your expertise to the next level, explore the 100% online programs offered by the American Dental Coders Association (ADCA). Enroll in our Certified Dental Billing Specialist (CDBS) or Certified Dental Coder (CDC) courses — or take both through our Dual Certification Program.
1. Increased Claim Denials and Payer Scrutiny
Dental insurers are applying more scrutiny to claims, resulting in more denials — even for routine procedures.
- Missing or incorrect CDT or ICD-10 codes
- Insufficient documentation
- Incorrect use of modifiers
- Policy exclusions not verified before treatment
Solution: Train your team on the latest CDT updates, perform internal audits, and implement a pre-submission quality control step. Our Certified Dental Billing Specialist (CDBS) course includes updated claim protocols for 2025.
2. Confusion Around Medical Cross Coding
More dental procedures are eligible for medical insurance reimbursement, but most practices lack cross coding knowledge.
- Sleep apnea appliances
- TMJ therapy
- Biopsies, trauma, and surgical extractions
Solution: Learn to use CPT and ICD-10 codes effectively. ADCA’s Certified Dental Coder (CDC) course covers medical-dental coding crossover in detail.
3. Staffing Shortages and Lack of Specialized Training
High turnover rates and limited training are causing revenue leaks and workflow slowdowns.
- Inexperienced front desk staff mishandling claims
- Underutilization of billing software tools
- Gaps in insurance verification and patient follow-up
Solution: Provide formal training through ADCA’s online certification programs. Cross-train team members to cover essential functions. Leverage billing automation where possible.
4. Lack of Clear Billing Protocols and Policies
Without standardized billing procedures, dental offices suffer from inconsistent submissions, slow reimbursements, and compliance risks.
Solution: Create a billing manual outlining claim processes, documentation standards, timelines, and handling of rejections. Update it annually based on payer trends and code changes.
5. Technology and Cybersecurity Risks
More practices are using cloud-based platforms — and becoming targets for cyberattacks. Data breaches can halt billing operations and result in HIPAA penalties.
- Lack of regular data backups
- Insecure login credentials and user access
- No cybersecurity training for staff
Solution: Implement HIPAA-compliant software, multi-factor authentication, and limit access levels. Regularly back up billing data offsite and train your team on security awareness.
6. Coordination of Benefits (COB) Errors
Incorrect handling of primary and secondary insurance leads to delays, denials, and frustrated patients.
Solution: Always verify COB before treatment. Submit claims in the correct order, attach primary EOBs, and follow each payer’s COB guidelines. These workflows are detailed in our Dual Certification Program.
7. Increased Documentation Requirements
Insurers are requesting more supporting documentation — and many claims are denied for insufficient justification.
- Missing clinical narratives or SOAP notes
- Absence of diagnostic images or referral letters
Solution: Use detailed clinical documentation tied to diagnosis codes. Automate documentation prompts in your EHR and train providers to write payer-ready notes. ADCA courses include documentation best practices aligned with current payer standards.
8. Outdated Code Usage and Version Control Issues
Using expired or incorrect CDT and ICD-10 codes continues to be a leading cause of claim delays.
Solution: Update your practice management software annually. Verify codes against current CDT and ICD-10 manuals. ADCA-certified coders stay current through ongoing education and alerts.
Why Certification Is the Best Solution
Most dental billing and coding issues can be prevented with proper training and a systematized approach. Certification shows employers you have the knowledge and skills to code and bill accurately — even in a constantly changing environment.
Already experienced and just need your credential? Take the exam directly:
Final Thoughts
Dental billing in 2025 comes with new challenges — but also new tools, technologies, and training to overcome them. The key is to stay educated, standardized, and proactive.
Whether you’re launching your career or improving your current practice workflows, certification through the American Dental Coders Association is your next best move.