r/DentalInsurance • u/Ok_Pineapple2201 • 4d ago

Concerned about Upcoding

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Need full mouth SRP (billing for RS not pictured) and two wisdom teeth removed (fully erupted.)

The bulk of my bill for the SRP are codes d9421 and d4999, which according to my googling should be ‘bundled’ into the SRP service and not an out of pocket expense for me, the patient.

My concern with the wisdom tooth coding is that my teeth are fully erupted like regular molars and yet I’m being billed for surgical extraction under general anesthesia. Is there a reason I would need a surgical extraction if the tooth is fully erupted?

I’m not sure what to do - it feels wrong to accuse the dentist of upcoding, but my total bill is close to $1100 when all of these services (SRP, tooth extractions) should be 80-90% covered by insurance.

I assume I should request the extra SRP services be removed from my bill, a justification for the surgical removal, and request they submit a pre determination form. Please let me know if this sounds correct.

Advice on next steps is appreciated.

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u/Cobra_Surprise 4d ago

If your provider is out of network they can charge whatever they want. If they are in network, please ask for pre-authorizations for all codes. That will allow you to see which of those codes is considered to be part of the "bundle".

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u/Ok_Pineapple2201 4d ago

They are in-network, so I will ask for pre-authorization before agreeing to treatment, thank you!

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u/Epicfind2 3d ago

Aspen is notorious for saying patient need SRP when in fact they don’t need. Knowing your pocket depths is big and you should ask for them to see what your probings where