# Dental billing & claims — reference and tools > How does a dental practice get insurance claims paid — from verification through denials, appeals, and prompt-pay deadlines? URL: https://dentovio.com/dental-billing Last verified: 2026-08-31 Dentovio is an independent publisher — not a dental insurance company, the American Dental Association, X12, or any government agency, and it is not affiliated with any payer named on these pages. This page was drafted with AI assistance and verified against the primary sources linked from each reference page. It has not been reviewed by a credentialed dental billing specialist, attorney, or clinician. CDT codes are referenced by number only; ADA descriptor text is never reproduced, and X12 code meanings are Dentovio's own paraphrases. Payer policies, plan terms, and statutes change and vary by plan. Educational billing reference only — not billing, legal, or clinical advice; plan contracts control individual outcomes. ## Direct answer Getting a dental claim paid runs through six stages: verify coverage before treatment, set the order of benefits when a patient holds two plans, submit with the documentation the payer's published criteria name, decode the denial codes on the remittance and write the appeal the plan's funding calls for, hold the payer to its state prompt-pay deadline, and read the plan terms — missing tooth clauses, alternate benefits, and frequency limits — that decide what was ever payable. This reference documents published claim-documentation criteria for 10 payers across 12 procedure families, 39 CARC denial codes with appeal verdicts and the appeal route by plan funding (fully insured, self-funded ERISA, or Medicaid managed care), prompt-pay statutes in 51 jurisdictions, and filing, appeal, and recoupment windows for 19 payers — each claim verified against the primary source it cites — plus free tools: a denial triage wizard, 4 appeal-letter generators, a prompt-pay interest calculator, a timely-filing deadline calculator, an order-of-benefits calculator, a claim-narrative builder for 3 procedure families, and insurance verification forms. A self-funded private-employer (ERISA) plan is generally beyond a state prompt-pay statute's reach and follows the federal claim-procedure deadlines instead, though that rule is neither statutory text nor categorical. ## What this reference covers today - 10 payers' documentation criteria - 39 denial codes with appeal verdicts - 51 state prompt-pay statutes - 6 revenue-cycle stages covered Coverage grows as each claim is verified against its primary source — a payer, code, or state missing here means "not verified yet," not "no rule exists." ## The revenue cycle, stage by stage ### 1. Verify coverage Confirm eligibility, plan terms, and history before treatment — the questions that prevent most downstream denials, and a script for the payer call. - [Insurance verification form, checklist & phone script](https://dentovio.com/dental-insurance-verification/index.html.md) ### 2. Order the benefits When a patient holds two plans, primary and secondary are set by rule, not by choice. The coordination rules, the math, and the birthday-rule tiebreaker. - [Coordination of benefits: rules & calculator](https://dentovio.com/dental-coordination-of-benefits/index.html.md) - [The dental insurance birthday rule](https://dentovio.com/dental-insurance-birthday-rule/index.html.md) ### 3. Document & submit Published claim-documentation criteria for 10 payers across 12 procedure families — what each payer's reviewers look for before they pay, read from the payer's own policy documents. - [Payer documentation requirements by procedure](https://dentovio.com/dental-claim-documentation/index.html.md) - [Claim narrative templates & builder](https://dentovio.com/dental-claim-narratives/index.html.md) ### 4. Decode the denial & appeal 39 CARC denial codes with meanings and honest appeal verdicts, plus a triage wizard and 4 letter generators that route the dispute by plan funding — fully insured, self-funded ERISA, or Medicaid managed care. - [Denial codes: meanings, verdicts & triage wizard](https://dentovio.com/dental-claim-denial-codes/index.html.md) - [Appeal letters: generators by plan funding](https://dentovio.com/dental-claim-appeal-letters/index.html.md) ### 5. Get paid on time Prompt-pay statutes in 51 jurisdictions — payment deadlines, the interest late payment triggers, and which statutes do not reach dental at all — with an interest calculator on each state page. - [Prompt-pay laws by state & interest calculator](https://dentovio.com/dental-prompt-pay-laws/index.html.md) - [Timely-filing limits by payer & deadline calculator](https://dentovio.com/dental-timely-filing-limits/index.html.md) ### 6. Read the plan terms The provisions that decide whether a service was ever payable, quoted from named plan documents rather than summarised into a payer-wide rule that does not exist. - [Missing tooth clause: what it excludes, and which plans carry one](https://dentovio.com/dental-missing-tooth-clause/index.html.md) - [Downgrades & alternate benefit provisions](https://dentovio.com/dental-insurance-downgrades/index.html.md) - [Frequency limitations & the counting rules](https://dentovio.com/dental-frequency-limitations/index.html.md)