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🔍  Understanding the Role of Narratives & Attachments

Dental billing isn’t just about coding and submitting claims, it’s about telling a clear and compelling story to insurance companies. Unlike medical billing, where standardized codes often suffice, dental claims require specific documentation, attachments, and narratives to justify treatment necessity.

Each Current Dental Terminology (CDT) code, governed by the American Dental Association (ADA), has specific documentation guidelines.

Let’s break it down procedure by procedure with visuals to make this easier!

🦷 Occlusal Guard- ADA D9944
📌 Attachments: Full Mouth Series X-ray(s)

✍ Narrative:
Patient presents with bruxism, occlusal wear, and associated head, neck, and jaw discomfort. A hard occlusal guard was prescribed to protect dentition and alleviate symptoms. Favorable prognosis.

Periodontal Maintenance - ADA D4910

📌 Attachments: Periodontal Charting
✍ Narrative: "Periodontal maintenance performed following previous SRP on [mm/dd/yyyy]. Patient requires continued periodontal therapy to prevent progression of disease."



PPE - ADA D1999

📌 Attachments: Itemized list of PPE used
✍ Narrative: "Personal protective equipment (PPE) used to maintain infection control during treatment in accordance with CDC guidelines."

Scaling & Root Planing (SRP) - ADA D4341/D4342

📌 Attachments: Full Mouth Series (FMS) X-rays & Periodontal Charting
✍ Narrative: "Scaling and root planing is necessary to remove subgingival microbiota, both alive and dead, to prevent further bone loss. Patient presents with bleeding on probing (BOP), inflammation, unattached gingiva, puffing interdental papilla, and 5mm+ pockets in each quadrant."

Osseous Surgery - ADA D4263/D4265

📌 Attachments: Intraoral photos
✍ Narrative: "Osseous surgery was necessary to detoxify the root surface and prevent further bone loss. Bone graft was placed to promote new attachment and bone regeneration."

Gingivectomy - ADA D4210/D4211

📌 Attachments: Periodontal Charting and X-rays
✍ Narrative: "Gingivectomy performed on [quadrant/teeth] to remove diseased tissue and reduce pocket depth, improving oral hygiene access."

Crown Lengthening - ADA D4249

📌 Attachments: PA X-ray and BW X-ray
✍ Narrative: "Crown lengthening needed on [Tooth #] due to improper biological width. Without the procedure, the crown margin would have been placed too close to the bone."

🦷 Pediatric Stainless Steel Crown - ADA D2931/D2930

📌 Attachments: Pre-op & Post-op X-ray
✍ Narrative:
"A stainless steel crown was placed on [Tooth #] due to extensive decay, fracture, or developmental defect. This restoration was necessary to maintain proper function, prevent premature tooth loss, and ensure long-term durability until natural exfoliation."

🦷 Veneer - ADA D2962

📌 Attachments: Pre-op & Post-op X-ray
✍ Narrative:
"Porcelain veneer placed on [Tooth #] due to enamel erosion, discoloration, or structural damage. The minimally invasive restoration improves aesthetics while preserving natural tooth structure. Veneer placement was necessary to restore function and enhance smile appearance."

Full Coverage Crown - ADA D2740/D2750

📌 Attachments: Pre-op and post-op X-ray
✍ Narrative: "Crown placed on [Tooth #] due to recurrent decay and failing restoration. The tooth required full coverage for structural integrity."

Core Buildup with Crown - ADA D2950

📌 Attachments: Pre-op X-rays and clinical notes
✍ Narrative: "Core buildup performed on [Tooth #] to support crown placement due to extensive loss of tooth structure."

PS: For CROWNS:

"Don't forget to all of placement is Initial or Replacement and if replacement add the replacement date (or ask the patient to estimate as closely as possible. Some insurance companies are anal and want prep and seat dates, we add them just to be safe!"

Protective Filling - ADA D2940

📌 Attachments: Pre-op X-rays and clinical notes
✍ Narrative: "Temporary filling placed to protect the tooth from further decay until permanent restoration is completed."

Inlay/Onlay Restoration - ADA D2650/D2662/D2643

📌 Attachments: Pre-op X-rays and clinical photos
✍ Narrative: "Inlay/Onlay placed on [Tooth #] due to fracture or decay that compromises cusp strength, preserving remaining tooth structure."

Implant Placement - ADA D6010

📌 Attachments: Full Mouth Series X-ray(s) & Panoramic X-ray
✍ Narrative:
"Implant placed at site [Tooth #], which was extracted on [mm/dd/yyyy]. Procedure necessary to maintain occlusal function, prevent bone resorption, and restore proper mastication. Implant placement was medically necessary to ensure long-term stability and function."

Abutment Placement - ADA D6056/D6057

📌 Attachments: PA X-ray & BW X-ray
✍ Narrative:
"Custom abutment placed on [Tooth #] to support final implant restoration. Abutment selection was based on optimal fit for occlusal function, tissue health, and prosthetic stability."

Implant-Supported Bridge - ADA D6075/D6076/D6077

📌 Attachments: Pre-op & Post-op X-ray
✍ Narrative:
"Implant-supported bridge placed between [Tooth #] and [Tooth #] to replace missing dentition. Bridge maintains arch integrity, prevents shifting, and restores functional occlusion."

Implant-Supported Denture - ADA D6110/D6111

📌 Attachments: Full Mouth X-ray(s) & Panoramic X-ray
✍ Narrative:
"Implant-supported denture fabricated for [Maxillary/Mandibular] arch to improve retention, stability, and patient function. The prosthesis enhances patient comfort and prevents further bone resorption."

Fixed Bridge - ADA D6740 (Pontic: D6245)

📌 Attachments: X-rays showing missing teeth and abutment health
✍ Narrative: "Fixed bridge placed on [Tooth #s] to replace missing teeth, restoring function and preventing shifting of adjacent teeth."

Dentures - ADA D5110/D5120

📌 Attachments: Pre-op X-rays and clinical notes
✍ Narrative: "Complete denture fabricated for [Maxillary/Mandibular] arch to restore full function following loss of teeth."

"Add teeth Extraction dates if possible or state of teeth were cogitatively removed before visit."

Alveoloplasty - ADA D7310

📌 Attachments: Pre-op X-rays and clinical notes
✍ Narrative: "Alveoloplasty performed in [specific quadrant/area] to contour and smooth alveolar ridges, facilitating proper healing and future prosthetic placement."

Partial Dentures - ADA D5213/D5214

📌 Attachments: Pre-op X-rays and clinical notes
✍ Narrative: "Complete denture fabricated for [Maxillary/Mandibular] arch to restore full function following loss of teeth."

"Add teeth Extraction dates if possible or state of teeth were cogitatively removed before visit."

🦷 Interim Partial Denture - ADA D5820

📌 Attachments: Full Mouth Series X-ray(s) & Panoramic X-ray
✍ Narrative:
"Interim partial denture placed for [Tooth #s] to restore function and aesthetics while awaiting definitive treatment. The patient plans to receive [permanent partial denture/implant-supported prosthesis] in the future. This temporary restoration maintains occlusal stability and prevents adjacent teeth from shifting."

📝 Narrative for Dual Insurance (Primary & State Medicaid as Secondary)

✅ Primary Insurance:
" Other Insurance (State Note): Secondary insurance is state/government dental.

"OR" 

for a more detailed Narrative per insurance plan request:

Patient has dual dental coverage.  Primary claim submitted to [Primary Insurance Name].  Secondary insurance is a state-funded plan, which will process benefits based on their allowed fee schedule. State Medicaid does not cover remaining balances beyond their allowable amount. Eligibility verified via [State Medicaid System Name]."

📢 Conclusion: The Clear Way to Claim Success!

At Clear Way Dental Claims, LLC, we understand that the smallest tweaks in narratives and documentation can mean the difference between instant approval and frustrating denials. A well-documented claim is a successful claim—insurance companies want clear, medically necessary justifications for every procedure.

By attaching the right evidence and writing concise, to-the-point narratives, you can increase claim approvals and improve revenue cycle efficiency. Many of our clients have seen significant reductions in denials simply by implementing these best practices.

✅ Key Takeaways:

✔ Always provide clear, concise narratives with the required attachments.
✔ Stay updated on ADA CDT codes and insurance-specific requirements.
✔ Avoid denials by submitting complete documentation the first time.
✔ Streamline the claim process by following proven best practices.

📌 Stay tuned for Part 2, where we’ll dive deeper into insurance-specific requirements and provide custom templates you can start using immediately!

💡 Need expert guidance? Let’s talk! Clear Way Dental Claims, LLC is your trusted partner in seamless, stress-free dental billing. 🚀