Starting out in dental billing can be intimidating, especially in a specialty like orthodontics, where billing works very differently from general dentistry. Unlike typical dental practices that bill per visit or procedure, orthodontic billing is based on long-term treatment plans, down payments, and monthly or quarterly claims — and that requires a unique approach.

If you’re new to orthodontic billing, don’t worry! Here are some essential tips to help you feel confident and set a strong foundation for success in your orthodontic practice.

1. Understand How Orthodontic Insurance Works

Orthodontic benefits are very different from general dental benefits. Instead of covering services based on frequency (like two cleanings per year), ortho coverage is typically:

• A one-time lifetime maximum per patient (e.g., $1,500 or $2,000).

• Paid out over time (monthly, quarterly, or annually).

• Applied to active orthodontic treatment only — not records, retainers, or consultation visits (though these may be billed separately).

Pro tip: Always verify if the ortho benefit is separate from or combined with the dental benefit. Some plans lump them together, which can cause coverage issues later.

2. Break Treatment into Phases for Billing

Orthodontic treatment is billed differently than fillings or crowns. It typically breaks down into:

• Initial records/diagnostic phase
  (e.g., exam, photos, X-rays, study models)

• Appliance placement/start of treatment

• Monthly or quarterly continuation of care

When billing insurance, you’ll usually:

• Submit the initial claim at the start of active treatment (banding/bracketing).

• Insurance will then pay a lump sum (typically 25-40%) upfront and schedule the remaining balance in installments.

Use code D8080 (comprehensive orthodontic treatment – adolescent) or D8090 (adult) depending on the case.

3. Master the Pre-Authorization and Verification Process

Before treatment begins, you should:

• Verify benefits thoroughly — including max lifetime ortho coverage, age limits, and remaining eligibility.

• Submit a pre-authorization with diagnostics and treatment plan (some carriers require this to pre-approve payment).

• Communicate clearly with patients about what insurance will pay vs. what they will owe.

Make sure you document:

• Start date

• Total treatment fee

• Estimated treatment duration

• Estimated insurance benefit and payment schedule

4. Use the Right Codes for Ortho Billing

You won’t need as many CDT codes in ortho as you would in general dentistry, but here are some commonly used ones:

• D0330 – Panoramic X-ray

• D0470 – Diagnostic casts

• D8080 – Comprehensive ortho treatment (adolescent)

• D8090 – Comprehensive ortho treatment (adult)

• D8670 – Periodic ortho visit (optional, sometimes used for progress tracking with certain payers)

• D8680 – Retainer delivery (sometimes not covered)

Be aware that not all carriers recognize the same codes, and some have unique requirements for documentation and progress reports.

5. Track Insurance Payments and Reconcile Carefully

Orthodontic insurance payments come in installments, and it’s easy to lose track if you’re not organized. Be sure to:

• Set up payment schedules in your practice management software.

• Follow up on missed or delayed payments — some plans stop paying if they don’t receive updates or if the patient changes employers.

• Maintain detailed records of what has been billed, what’s been paid, and what’s still pending.

6. Coordinate Benefits (COB) When Two Plans Are Involved

If a patient has dual coverage, you need to know which plan is primary and how benefits are coordinated. Keep in mind:

• Many insurance companies won’t pay beyond the total orthodontic lifetime max across both plans.

• Some secondary plans will only pay if the primary pays less than the allowable amount.

• Always submit claims in order: primary first, then secondary with the EOB attached.

7. Keep the Parents (or Patients) in the Loop

In ortho, you’re typically billing a parent or guardian — not the patient. Clear communication is key:

• Explain the insurance breakdown, including what is covered and what isn’t.

• Be clear about how payments are structured (monthly, quarterly, etc.).

• Remind parents that if insurance terminates early, they are responsible for the remaining balance.

8. Watch for Age Limits and Waiting Periods

Some orthodontic plans only cover treatment up to a certain age — often under 19 or before age 26 (if the patient is a dependent). Others have waiting periods before ortho benefits kick in.

Always check for:

• Effective date of coverage

• Ortho-specific waiting period

• Eligibility based on age at treatment start

Final Thoughts

Orthodontic billing is more about long-term tracking, coordination, and communication than fast-paced daily billing. Once you understand how benefits are structured and how insurance pays over time, it becomes much more manageable — even enjoyable!

Stay organized, follow up consistently, and always double-check insurance before starting treatment. With a strong foundation, you’ll become a key player in helping patients (and their parents) understand their financial responsibilities and keeping the office running smoothly.