Denial appeals · Dental
Downcoded, “frequency-limited,” and denied. Dental payers count on you not appealing.
Dental denials hide in adjustments: perio treatment downcoded to a prophy, surgical extractions denied for necessity, frequency limits applied wrong, missing-attachment denials on claims you attached everything to. Each is appealable — with the right exhibit list.
Free for your first 10 claims. Then 15% of recovered revenue only — upheld denials cost you nothing.
The denials you're seeing
We know these EOBs by heart.
| Denial | What the payer said | Why it's often winnable |
|---|---|---|
| Downcoding | D4341/D4342 paid as prophylaxis (D1110) | Perio charting with pocket depths and radiographic bone loss is the evidence standard. We assemble it into an appeal the consultant has to address. |
| CO-50 | Not medically necessary — surgical extractions, build-ups | Payer clinical criteria are specific; the denial rarely engages your radiographs and narrative. We make them. |
| Frequency | Limitation applied incorrectly | History errors and plan-coordination mistakes cause wrongful frequency denials — verifiable and reversible. |
| CO-16 | Missing attachments / documentation | Often payer-side intake failure. Proof of attachment plus resubmission recovers these quickly. |
| EOB games | Bundled or 'inclusive' procedures | CDT definitions and separate-procedure narratives defeat improper bundling. |
How we fight them
Specialty-specific arguments, not form letters.
Radiographs + charting + narrative
Dental appeals are won on exhibits. We specify exactly which images, charting pages, and narrative points each appeal needs — numbered, in order.
Clinical criteria mapping
Dental consultants deny fast and generic. A letter that quotes the plan's own clinical policy forces individualized review.
COB denials
Dual-coverage denials are frequently just sequencing errors — cheap recoveries hiding in your aging report.
Free 10-claim pilot
Find out what your write-offs were actually worth.
Tell us a little about your practice. We'll reply within one business day with the BAA and a secure upload link.