Let’s talk about the most expensive two days in dentistry.

Not a missed implant case.
Not a broken crown.
Not even a downgraded SRP.

I’m talking about 5 months and 28 days.

Because somewhere in America right now, a perfectly wonderful patient is sitting in your chair saying:

“But you told me I get two cleanings a year.”

And somewhere in an insurance cubicle, a computer just stamped your claim with a big digital DENIED.

Welcome to the semantic battlefield of dental insurance frequency limitations.

The Three Frequency Personalities

1️⃣ Twice per Calendar Year

Sounds generous, right?

This plan allows:

• A cleaning in December

• Another cleaning in January

• Two visits… within 30 days.

Totally legal. Totally payable.

This is the unicorn plan. Rare. Magical. Slightly confusing, but manageable.

Now we enter the fine print zone.

“Once every 6 months” does not mean:

• January and July (unless the math works perfectly)

It means:

• A full 180 days must pass.

If the patient arrives at:

5 months and 28 days?

Denied.

Not “almost covered.”
Not “close enough.”
Not “you tried.”

Denied.

And guess who the patient is mad at?

Hint: It’s not the carrier.

3️⃣ Twice in a 12-Month Rolling Period

This one is the ninja of frequency rules.

“Twice in a 12-month rolling period” means:

• The insurance company looks backward 12 months from today

• If there were already two cleanings in that window… denied.

It doesn’t care about calendar years.
It doesn’t care about good intentions.
It doesn’t care that your hygienist’s schedule was tight.

It cares about math.

The Real Problem Isn’t Insurance
It’s Assumptions.

When your team says:

“You’re covered for two cleanings a year.”

That’s not verification.
That’s optimism.

And optimism does not override frequency limitations.

You know this.
I know this.
But the patient doesn’t.

And when the claim is denied, your practice, not the insurance carrier, absorbs the reputational damage.

That’s the trap.

How Smart Practices Avoid It
This isn’t about being paranoid.

It’s about being precise.

1️⃣ Specific Verification

Stop asking:

“Are cleanings covered?”

Start asking:

• Is it calendar year?

• Is it 180 days?

• Is it rolling 12 months?

• What was the last paid date?

• What is the next eligible date?

That last question alone can save you thousands annually in write-offs and awkward phone calls.

2️⃣ Proactive Scheduling

Mark the earliest eligible date in your software.

If you use:

• Dentrix

• Eaglesoft

• Open Dental

• Dentrix Ascend

There are ways to flag or note eligibility dates directly in the patient ledger or continuing care settings.

Don’t rely on memory.
Don’t rely on “it’s about six months.”
Rely on documented math.

3️⃣ Patient Education (Before the Denial)

This is leadership.

Instead of saying:

“You’re covered twice a year.”

Say:

“Your plan allows two cleanings in a 12-month rolling period. Based on your last visit, your next insurance-eligible date is July 14. If you’d like to come earlier, we can absolutely do that, there may just be a patient portion.”

That one sentence:

• Protects trust

• Prevents surprise bills

• Makes you look organized and transparent

Patients don’t get upset about rules.
They get upset about surprises.

The Bigger Lesson

Benjamin, you talk all the time about protecting the financial integrity of quality care.

This is one of those invisible battlegrounds.

Not glamorous.
Not clinical.
Not Instagram-worthy.

But administrative precision is what separates:

Chaotic practices
from
Confident ones.

Two days can cost:

A claim
A collection
Or worse… a relationship

But attention to detail?

That builds trust.

Final Thought

Insurance companies are not vague.
They are specific.

If we want paid claims, predictable cash flow, and fewer frustrated patients…

We must be more specific than they are.

Because in dentistry, sometimes the difference between paid and denied isn’t skill.

It’s semantics.

And leadership lives in the details.

Benjamin Tuinei
Founder – Veritas Dental Resources, LLC
📞 888-808-4513
Services: PPO Fee Negotiators, PPO Fee Negotiating, Insurance Fee Negotiating, Insurance Credentialing, Insurance Verifications
Websites: www.VeritasDentalResources.com, www.VerusDental.com