Ortho Insurance Billing Cheat Sheet

Insurance Billing Nuances

Keep the following factors in mind when billing clear aligner treatment to your patient’s insurance. 

  • Ortho claims are determined and paid over the course of treatment. If eligibility is terminated during the course of treatment, ortho payments stop!
  • Ortho is considered a separate benefit and has a once per lifetime eligibility.
  • Most carriers pay a percentage of the total fee up to the ortho lifetime max.
  • Many carriers are providing adult ortho coverage. Some may or may not have age limits, i.e. 19, 26,  or no limit.
  • Carriers will pay a portion of the submitted charges upfront and the remainder is paid either monthly,  quarterly, semi-annually, or annually.
  • Most major carriers require only an initial claim and will pay automatically based on a schedule. ݴ Some carriers will require continuous claim filing by the provider (i.e. monthly/quarterly). 

Claim filing information

When filing a claim, be sure to include the information below to avoid delays in claim processing. 

Description of the malocclusion Class I, II, III 

Procedure date (actual date of aligner delivery must match the date in box 41)

Total treatment fee 

Down payment 

Monthly payment 

Estimated total months of treatment

Clear aligner upgrade charge 

Examples of Ortho Coverage Max

The ortho max is $1500, ortho benefit is 50%

Insurance will pay 50% of UCR (usual,  customary, and reasonable charge) or contracted rate (depending on out of network/ in network status) up to the lifetime max of $1500. 

Orthodontic Billing Codes

Examination Codes

D8660                    Orthodontic Exam & Evaluation (Separate from D0150 or


Records Codes

D0350                    2D Oral/ Facial Photo Images

D0330                    Panoramic Image (Once Every 2-5 Years, Depending on


D0470                    Diagnostic Casts / Study Models (Scans Count)

Treatment Codes

D8090                    Comprehensive Tx of The Adult Dentition

D8040                    Limited Orthodontic treatment: adult dentition (use for

                                single arch cases)

D8670                    Periodic orthodontic treatment visit (Code for

                                monthly/quarterly billing) 

D8999                    Miscellaneous code - Clear Aligners (Allowable

                                upcharge from your contracted rate on some plans)  

D9951                     Limited occlusal adjustment 

                                (occ. equilibration, Incisal edge reshaping) Most major

                                carriers could cover up to 50-80% (plans may vary). Bill

                                separately once occlusal adjustment is done.

Insurance verification 

We recommend adding the following questions to your insurance verification process/form.

  • Ortho lifetime max
  • Coverage percentage
  • Age limitations
  • If records codes are covered and considered part of the preventative, basic or orthodontic benefit
  • Claim submission frequency (i.e. monthly, quarterly, etc)
  • Percentage paid at placement

Example of Required Fields on Ortho Claim 

Dandy Ortho Insurance Billing Cheat Sheet PDF

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