Orthodontic billing does not work like the rest of dentistry. A single case can run for two years. The fee is set once and collected over many months. Insurance usually pays a portion at the start and the rest in installments, against a lifetime maximum instead of an annual one. Patients change plans, turn 19, or move partway through treatment. Maximum Billing handles orthodontic insurance billing so that the insurance share of each case is collected on schedule and nothing is left unbilled when coverage changes.
Schedule a consultation or call 800-820-0364.
Why Orthodontic Billing Is Different
- One fee, many payments. The case fee is agreed at the start, then collected through an initial payment and periodic payments from both the plan and the patient.
- Lifetime maximums. Most dental plans that cover orthodontics apply a separate lifetime orthodontic maximum, not the annual maximum used for other dental work.
- Age limits. Many plans cover orthodontics only for dependent children, often up to age 19, and some exclude adult orthodontics entirely.
- Installment payments. Plans commonly pay part of their benefit when appliances are placed and the rest monthly or quarterly. Some require each installment to be claimed. Others pay automatically once the case is set up.
- Long timelines. Over 18 to 30 months, patients change jobs, plans, and eligibility. A case that was fully covered at banding may not be by the end.
The CDT Codes Orthodontic Practices Bill
The descriptions below are short summaries. Check the current CDT manual for the full descriptors.
- D8010 to D8040: limited orthodontic treatment of the primary, transitional, adolescent, and adult dentition.
- D8070, D8080, and D8090: comprehensive orthodontic treatment of the transitional, adolescent, and adult dentition. Clear aligner cases are generally reported with these treatment codes as well.
- D8660: pre-orthodontic treatment examination to monitor growth and development.
- D8670: periodic orthodontic treatment visit.
- D8680: orthodontic retention, including removing appliances and placing retainers.
- D8695: removal of fixed appliances for reasons other than completing treatment.
- D8703 and D8704: replacement of a lost or broken retainer, maxillary and mandibular.
- Records: diagnostic images such as D0330 (panoramic), D0340 (cephalometric), and D0350 (photographic images) are billed with the diagnostic codes, subject to the plan’s rules.
Our guide to CDT codes covers the full code set and the coding mistakes that most often lead to denials.
Setting Up an Orthodontic Claim Correctly
Most orthodontic payment problems start with how the case is set up with the plan. A complete initial claim usually needs:
- The banding date, or appliance placement date, as the treatment start date.
- The total case fee and how it is divided between the initial and periodic payments.
- The estimated length of treatment in months.
- Diagnostic records, if the plan requires them, and pre-authorization where the plan asks for it.
If any of these are missing or wrong, the plan may pay the wrong amount, stop paying installments early, or never set up the installment schedule at all. Our guide to dental insurance claims processing explains how dental plans process claims.
Checking Orthodontic Benefits Before Treatment
A basic eligibility check confirms that the patient has coverage. It does not show what the plan will pay for orthodontics. Before a case starts, the questions that matter are:
- Does the plan cover orthodontics for this patient’s age?
- What is the lifetime orthodontic maximum, and has any of it been used?
- What percentage does the plan pay, and is there a separate deductible?
- How does the plan pay: a lump sum at the start, installments, or both?
- Is there a waiting period, and is pre-authorization required?
- If treatment started under another plan, will this plan cover the remaining months?
Our dental insurance verification services page explains what a full benefits breakdown includes.
When Coverage Changes Mid-Treatment
- New plan. When a patient changes plans, the new plan’s rules for treatment already in progress decide what it will pay for the remaining months. Some pay a share of the remaining treatment, and some pay nothing for cases that started before coverage began.
- Two plans. When a patient is covered by two dental plans, coordination of benefits applies to orthodontics too, and each plan’s lifetime maximum has to be tracked separately.
- Aging out. When a dependent reaches the plan’s age limit during treatment, coverage for the rest of the case may end.
- Loss of coverage. If coverage ends, the remaining balance usually becomes the patient’s responsibility, and the patient’s financial agreement should already say so.
Each of these changes the split between what the plan owes and what the patient owes. When the insurance side is not updated, the practice either undercollects or bills the patient for amounts the plan should have paid.
Medicaid and Orthodontics
Medicaid programs generally cover orthodontics for children only when it is medically necessary, not for cosmetic reasons. Many states assess medical necessity with a scoring index, such as the Handicapping Labio-lingual Deviation (HLD) index, and require prior authorization with records before treatment begins. The rules, forms, and scoring differ by state and by Medicaid dental plan.
Where Orthodontic Practices Lose Revenue
- Installment payments that stopped and were never followed up.
- Cases set up with the wrong treatment length or fee, so the plan paid the wrong amount.
- A second plan never billed for coordination of benefits.
- Coverage changes mid-treatment that were never reported to the new plan.
- Retainer replacements and appliance repairs billed incorrectly or not at all.
- Patient balances that were never adjusted after the insurance share changed.
What Our Orthodontic Billing Includes
- Orthodontic benefits checks before treatment, including lifetime maximums, age limits, and payment method.
- Initial claims and pre-authorizations with the banding date, case fee, and treatment length.
- Tracking installment payments for every active case.
- Coordination of benefits when a patient has two plans.
- Follow-up on unpaid and underpaid claims, and appeals.
- Updates when a patient’s coverage changes during treatment.
We sign a Business Associate Agreement with every client, and every team member completes HIPAA certification. As of 2026, our clients’ claims reach a 91% clean claim rate, and their accounts receivable average 34 days. We work in Eaglesoft, Dentrix, Dentrix Ascend, and Open Dental. If your practice uses an orthodontic-specific system, ask us about it.
See our dental billing services and dental credentialing services, or read how to choose a dental billing company.
Frequently Asked Questions
How does dental insurance pay for orthodontic treatment?
Usually through a lifetime orthodontic maximum, paid partly when appliances are placed and the rest in installments over the course of treatment. The exact method depends on the plan.
Which CDT codes are used for braces?
Comprehensive treatment uses D8070, D8080, or D8090, depending on the stage of the patient’s dentition. Limited treatment uses D8010 to D8040.
What happens if a patient changes insurance during treatment?
The new plan’s rules for treatment in progress decide what it will pay for the remaining months. The case has to be reported to the new plan, and the patient’s balance adjusted.
Does Medicaid cover braces?
Generally only for children, and only when treatment is medically necessary under the state’s criteria. Prior authorization is usually required.
Talk to Us About Your Orthodontic Practice
Tell us how many active cases you have and which plans your patients use, and we will review your outstanding orthodontic claims with you. Contact us to schedule a consultation, or call 800-820-0364.