The 2025 Dental Insurance Changes That Could Cost Your Practice (Unless You Fix Them Now)
- Sarah Beth Herman
- Apr 3
- 4 min read
By Sarah Beth Herman, CEO of Dentistry Support®
Dental billing and insurance verification aren’t just back-office tasks—they are the backbone of your collections and patient experience. In early 2025, our team at Dentistry Support® implemented a detailed training after working with dozens of new client offices who were running into preventable insurance problems.
Whether you're part of a billing team, managing a front desk, or supporting eligibility verifications virtually, this training is for you. Let me walk you through the biggest takeaways and how you can apply them to avoid unnecessary denials, delays, and lost revenue.
1. CDT 2025 Code Updates Are Not Optional
One of the most overlooked mistakes we saw? Offices still using outdated codes. For example, full-mouth debridement (D4355) now must be followed by a comprehensive exam, not performed the same day. This was one of many changes released in CDT 2025.
Here are a few critical codes your team needs to understand:
D0356 – Cone Beam CT capture & plan
D8676 – Orthodontic periodic visit with surgical coordination
D9998 – Treatment Plan Coordination
The American Dental Association released 10 new CDT codes, revised 8, and deleted 2. These updates reflect the growing scope of procedures in general dentistry, surgical treatments, and diagnostic workflows. Missing or misusing these codes can result in outright denials or prolonged processing times that impact your cash flow.
What You Can Do:
Double-check that your dental software has updated the CDT codes
Review all procedure templates to ensure new codes are included
Train your team on which procedures require attachments (x-rays, narratives, perio charts)
Official Resource: ADA CDT 2025 Guidebook
2. Umbrella Plan Confusion Is Still Costing You Patients
We had multiple new offices join us this year who were unknowingly verifying plans under the wrong networks. For instance, a Guardian plan may actually process under Aetna PPO. Missing this detail can result in patients being incorrectly told they are out of network.
According to the National Association of Dental Plans (NADP), more than 250 million Americans rely on a dental benefit network—and many of those networks use umbrella administration. That means a plan may be managed by a larger third-party administrator, not the name on the card.
Common Umbrella Examples:
Guardian processed under Aetna PPO
Cigna processed through Connection Dental
United Concordia under DenteMax
What You Can Do:
Build a shared list of umbrella networks and group number aliases
Always verify with the rep: "Is this plan administered under a different carrier?"
Train your verifiers to never assume what's printed on the insurance card is the full story
Helpful Resource: NADP Umbrella Network Trends
3. New Best Practice: Claim Follow-Up Every 10 Days
Effective April 15, 2025, our internal teams began following up on every submitted claim every 10 days, instead of every 14+. According to the ADA’s Health Policy Institute, the average claim processing time across most PPO plans is 17–22 days. However, over 30% of dental claims are initially rejected due to missing information. This means proactive follow-up is not just best practice—it’s critical.
Why This Matters:
Most claims left unpaid after 30 days had simple fixable issues
Early follow-up gives time to resubmit or send missing documentation
Faster payments keep cash flow steady and reduce AR stress
What You Can Do:
Adopt a 10-20-30 follow-up cadence:
Day 0: Claim submitted
Day 10: First status check
Day 20: Second status check
Day 30: Final check
Use a spreadsheet, software task, or checklist—whatever works for your team
4. Why You Should Never Use $0 on a Claim
Offices often try to submit a code for documentation only, entering $0 in the fee field. The intent is good, but the result can be harmful.
Here’s what happens:
Some payers flag $0 claims as suspicious or abusive
You risk triggering audits or full claim processing delays
Clearinghouses may bounce the claim altogether
In fact, major clearinghouses like Tesia and Availity recommend that offices always submit UCR fees, even when submitting non-covered services, with proper notation to avoid data errors in claim streams.
What You Can Do:
Always use your UCR (Usual Customary Rate)
Add a note: “Submitted for documentation only; not billable under the plan.”
Train your team that $0 is not a workaround—it’s a liability
Final Thoughts from Sarah Beth Herman
If your practice feels overwhelmed by insurance processes or short on time to train your team—you’re not alone. Many of the offices we've supported since January 2025 have faced these exact issues. And that's why we exist.
We know your team is busy. We know claim rules change constantly. But with a solid structure, the right coaching, and clear follow-up systems, you can take control of your billing and eligibility processes.
I created this free training to help not just our internal team, but every dental professional out there who is tired of seeing claims denied or payments delayed. If you're looking for one-on-one support, done-for-you billing help, or eligibility verifications that actually work, let’s talk. I mentor, coach, and build systems for dental practices just like yours.
All of my mentoring, coaching, and services are linked below.
You deserve to run a practice that gets paid faster and more consistently. No silver spoons here—just real work, the right way.
References & Resources:
ADA CDT 2025 Codebook: https://www.ada.org/publications/ada-catalog/cdt-products
NADP Industry Briefs on Network Trends: https://www.nadp.org/Reports/ResearchBriefs.aspx
ADA HPI: Claims Rejection and Processing Time Study: https://www.ada.org/resources/research/health-policy-institute
Dentistry Support®: https://www.dentistrysupport.com
Disclaimer:
To learn more about Sarah Beth Herman, the author of all free training content you can read her bio here. These materials are intended to provide helpful information to dentists and dental team members. They are in no way a substitute for actual professional advice based on your unique facts and circumstances. This content is not intended or offered, nor should it be taken, as legal or other professional advice. You should always consult with your own professional advisors (e.g. attorney, accountant, or insurance carrier). To the extent, Dentistry Support ®has included links to any third-party website (s), Dentistry Support ® intends no endorsement of their content and implies no affiliation with the organizations that provide their content. Further, Dentistry Support ® makes no representations or warranties about the information provided on those sites. You can view our privacy policy and terms and conditions by clicking those pages in the footer of our website.
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