Starting out in dental billing can feel overwhelming — especially in a specialty practice like oral surgery, where the procedures are more complex, the claims often involve both dental and medical insurance, and documentation is critical. But don’t worry — with a little guidance and a solid workflow, you'll find your footing quickly.

Here are some key tips and insights to help you succeed in your new role as a billing coordinator in an oral surgery office.

1. Know the Common Oral Surgery Procedure Codes

You’ll work with a mix of CDT (dental) and sometimes CPT (medical) codes. Here are some of the most frequently used CDT codes in oral surgery:

• D7140 – Simple extraction (erupted tooth)

• D7210 – Surgical removal of erupted tooth (requires elevation and/or sectioning)

• D7220–D7240 – Impacted tooth removal (soft tissue, partial bony, full bony)

• D7280 – Surgical access of unerupted tooth

• D7286 – Biopsy of oral tissue

• D7510/D7520 – Incision and drainage of abscess (intraoral vs. extraoral)

• D7953 – Bone graft for ridge preservation

• D9222/D9223 – General anesthesia (first 15 minutes and each additional 15)

• D9310 – Consultation

Pro tip: Many of these procedures are site-specific — always confirm and document tooth numbers or areas being treated.

2. Dental vs. Medical Billing: Know When to Use Each

Oral surgery is one of the few dental specialties that often bills both dental and medical insurance. Here’s a quick rule of thumb:

• Use dental insurance for:

  • Routine extractions

  • Bone grafts

  • Socket preservation

  • Dental pathology

• Use medical insurance when:

  • Treatment involves impacted teeth, trauma, infections, cysts, or tumors

  • Anesthesia or sedation is performed due to medical necessity

  • Surgery is performed in a hospital or surgical center

Submit to medical first when applicable, then to dental with the medical EOB attached.

3. Verify Insurance Thoroughly — Both Medical and Dental

Before the procedure:

• Verify dental AND medical benefits, especially for:

  • Wisdom teeth

  • General anesthesia

  • TMJ treatment

  • Biopsies

  • Pathology removal

• Check for:

  • Waiting periods

  • Frequency limitations

  • Age restrictions (especially for impacted teeth)

  • Preauthorization requirements

Always confirm coordination of benefits if the patient has dual coverage.

4. Master Pre-Authorizations and Documentation

Many oral surgery procedures require pre-authorization, especially from medical insurance. Always be ready to submit:

• Panoramic X-rays or 3D scans

• Clinical notes

• Narratives describing the patient’s condition, symptoms, and need for surgery

• Diagnosis codes (ICD-10) when billing medical

Example: For impacted wisdom teeth, include a narrative like:
“Patient presents with pain, pericoronitis, and radiographic evidence of mesioangular impaction on tooth #17. Extraction required due to infection risk.”

5. Track Anesthesia Time Accurately

Billing for general anesthesia or IV sedation is time-based, not flat-rate. You’ll use:

• D9222 – Deep sedation/general anesthesia, first 15 minutes

• D9223 – Each additional 15 minutes

Start timing when sedation begins, not when the procedure starts, and document the total anesthesia time precisely.

6. Educate Patients on Coverage and Costs

Oral surgery procedures are often high-ticket items, and insurance may not cover the full cost. Help patients understand:

• What insurance will pay

• What’s considered non-covered (e.g., elective sedation)

• What their estimated out-of-pocket will be

• Their options for financing or payment plans

Be clear that medical insurance doesn't always guarantee coverage for dental-related procedures, and vice versa.

7. Stay Organized with Post-Op Claims and Hospital Billing

If your surgeon performs procedures in a hospital or surgery center, keep track of:

• Separate billing requirements for facility fees vs. professional fees

• Special codes for post-op visits (often bundled)

• Whether anesthesia was administered by your team or a separate provider

8. Handle Emergency and Trauma Cases Efficiently

Oral surgery offices often deal with emergencies — facial trauma, dental infections, or jaw fractures. In these cases:

• Act fast to verify medical coverage

• Use the appropriate ICD-10 trauma codes

• Submit claims to medical first, especially for ER cases

Final Thoughts

Oral surgery billing is a highly specialized role that blends dental and medical billing, surgical coding, anesthesia documentation, and complex insurance verification. While it may feel like a lot at first, you’ll quickly grow into the role with practice and support from your clinical team.

Stay organized, document everything, verify thoroughly, and always advocate for clear patient communication — and you’ll be on your way to becoming an indispensable part of the oral surgery practice.