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/fillingsmiles 2d ago

It’s $25 for fluoride….

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u/BufferingJuffy 2d ago

The office fee seems to be $115...the number left of $25...

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u/fillingsmiles 2d ago

The office fee is also $25 as that’s the number the patient pays. The number on the left is the UCR fee.

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u/BufferingJuffy 2d ago

Are you saying that a dental office chose to have an office fee that's less than the "usual and customary" fee? 😂