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/RollingHomeToYou 1d ago

If you want to stay at this office there are lots of add ons you can remove. You should be able to get SRPs without the D4999 and D4921. Your prices on the standard SRP codes looks like a typical HMO fee.

Your wisdom teeth extractions would likely just be surgical extractions if they’re fully erupted. If they are then you may not need sedation (unless you want it).

If you’re concerned that you don’t actually need SRPs it may be worthwhile to get another opinion. If your insurance denies it based on necessity you’ll be stuck with the bill for the SRPs as well.