It’s one of the biggest headaches in the dental front office: you send in a claim, wait weeks, and then—denied. The reason? “Lack of documentation” or “insufficient narrative.”

If that makes your blood boil, you’re not alone.

But here’s the good news: improving how you write narratives and attach documentation can drastically increase your claim approval rate. And it’s not about writing essays—it’s about writing smart, specific, and complete.

Let’s break down exactly how to do that.

What Is a Narrative (and Why Does It Matter)?

A narrative is a brief explanation submitted with a claim to justify why a procedure was necessary. Insurance companies use it to decide whether they’ll pay.

Too often, offices send in claims with no narrative or a generic one like:

“Patient had pain.”
“Tooth had decay.”
“Crown needed.”

These vague notes don’t help—and they’re a top reason for delays and denials.

A strong narrative is your voice in the approval process. Use it to clearly and quickly show the medical necessity of the treatment.

The 3 Essentials of a Strong Dental Narrative

Every effective narrative should include:

1. Symptoms

What did the patient experience?

• Pain (how often? how severe?)

• Sensitivity (to hot, cold, pressure?)

• Swelling or infection?

Example: “Patient reports lingering cold sensitivity and pressure pain in tooth #30 for 2 weeks.”

2. Clinical Findings

What did you observe or diagnose?

• Fractures or large restorations?

• Decay under margins?

• Mobility, probing depths, inflammation?

Example: “Tooth has a fractured cusp and recurrent decay under existing MOD amalgam.”

3. Radiographic Evidence

What do the X-rays or photos show?

• Periapical radiolucency?

• Bone loss?

• Recurrent decay?

Example: “Radiographs confirm decay under restoration with proximity to pulp.”

These three components tell a clear story: what the patient felt, what you saw, and what the images confirmed.

What Procedures Usually Require Narratives?

Some claims can get by with minimal notes, but others almost always require strong documentation:

• Crowns

• Scaling and root planing (SRP)

• Periodontal maintenance

• Core buildups

• Occlusal guards

• Palliative (emergency) visits

• Endo retreatments

• Extractions with complications

If it’s not routine—and it costs more—insurance will want proof.

Tips to Make Narratives Faster and Easier

Use templates—but customize them.
Start with a basic structure for each procedure, but always personalize based on the patient’s actual case. Insurance reviewers can spot a copy-paste job from a mile away.

Include diagnostic codes (if applicable).
Codes like D0170 (limited re-evaluation) or D9310 (consultation) help support your narrative when additional diagnosis is involved.

Train your team to gather info up front.
Have assistants or hygienists document symptoms and probing depths clearly in the chart. This makes narrative-writing a breeze later.

Attach supporting documentation.
Don’t forget radiographs, perio charting, photos, and intraoral images. A solid narrative with no images won’t always make the cut.

Real-World Example: Crown Claim Narrative

Wrong:

“Tooth #14 needs a crown due to large filling.”

Better:

“Tooth #14 has a fractured mesiobuccal cusp, sensitivity to pressure and cold, and recurrent decay under existing MO composite. Periapical X-ray confirms proximity to pulp. Full coverage restoration recommended to prevent further fracture.”

This version tells the full story—clearly and concisely.

When in Doubt, Think Like a Reviewer

Put yourself in the shoes of the insurance rep reviewing 200 claims a day. They’re asking:

• Why does this tooth need this procedure now?

• Is there evidence to support the claim?

• Could a less expensive option have worked?

A good narrative answers all three—before they ask.

Final Takeaway

Narratives aren’t just annoying paperwork. They’re your case for getting paid. When done right, they prevent denials, speed up claim processing, and give your practice the reimbursement it deserves.

Strong narratives start with strong documentation. Build a system in your office, train your team, and take pride in telling the clinical story behind every procedure.

Benjamin Tuinei

Founder - Veritas Dental Resources, LLC
Phone: 888-808-4513

Services:
PPO Fee Negotiators | PPO Fee Negotiating | Insurance Fee Negotiating
Insurance Credentialing | Insurance Verifications

Websites:
www.VeritasDentalResources.com | www.VerusDental.com