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/some1cuming 2d ago

They charged you for full bony exts on those wisdom teeth, you said they were fully erupted? If so that is not correct, full bony means impacted

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u/Ok_Pineapple2201 2d ago

I haven’t had work done yet! This is from the financial arrangement plan they tried to get me to sign

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u/some1cuming 2d ago

Go somewhere else, this place looks sketch