Dental Billing Services for Florida Practices
Maximum Billing, LLC provides dental billing and revenue cycle management for practices across Florida. We handle the full billing lifecycle — eligibility and breakdowns, claim submission with attachments, payment posting, denial appeals, patient balances, and credentialing — so your front desk can stop chasing insurance and get back to patients.
We are based in Fort Myers and have specialized in dental and mental health billing since 2018, backed by more than 20 years of hands-on experience in insurance billing and revenue management. We work with practices from Naples and Cape Coral to Tampa, Orlando, Jacksonville and Miami.
Dental billing is not medical billing with different codes. The benefit structures, the attachment requirements, and the ways a claim gets quietly reduced instead of denied are specific to dentistry, and they are where most practices lose money without ever seeing it.
What We Handle
- Insurance verification and full benefit breakdowns before the appointment
- Accurate CDT coding and claim review prior to submission
- Claim submission with the narratives, X-rays and perio charting payers require
- Pre-determinations for major treatment plans
- Payment posting, including write-off accuracy against your contracted fees
- Denial management, appeals and resubmission
- Accounts receivable follow-up on a schedule
- Medical billing for dental procedures where coverage allows
- Provider credentialing and payer enrollment
- Patient balance billing and statements
The CDT Codes Behind a Dental Claim
Clean claims start with correct coding and documentation that supports it. These are the code families we work in every day:
- Diagnostic — D0120, D0150, D0210, D0220, D0274, D0330. Periodic and comprehensive exams, full-mouth series, periapicals, bitewings and panoramic images. Frequency limits on exams and images are among the most common sources of quiet denials.
- Preventive — D1110, D1120, D1206, D1351. Adult and child prophylaxis, fluoride varnish and sealants, each with its own age and frequency rules that vary by plan.
- Restorative — D2140 through D2394, D2740, D2750, D2950. Amalgams and composites by surface count, crowns, and build-ups. Posterior composites are the classic downgrade target.
- Endodontics — D3310, D3320, D3330. Anterior, bicuspid and molar root canals, frequently requiring pre-operative and post-operative imaging.
- Periodontics — D4341, D4342, D4910. Scaling and root planing by quadrant, and periodontal maintenance. These almost always require perio charting with pocket depths, and are denied without it.
- Oral surgery — D7140, D7210, D7220 through D7240. Simple and surgical extractions, including impacted teeth by depth of impaction — a distinction payers audit closely.
- Prosthodontics and implants — D5110, D5213, D6010, D6058. Dentures, partials, implant placement and implant-supported crowns, where missing tooth clauses and waiting periods decide coverage more often than clinical need.
For a fuller list of codes and the coding mistakes that cause denials and downgrades, see our guide to CDT codes.
Where Dental Claims Actually Fail
Dental claims rarely fail for dramatic reasons. They fail quietly, in ways that look like normal adjustments on an EOB:
- Alternate benefit downgrades. A posterior composite paid at the amalgam rate, or a porcelain crown paid at a base-metal rate. The claim is not denied, it is simply paid less — and if nobody is checking the EOB against your fee schedule, it is never caught.
- Frequency limitations. Two cleanings per benefit year, bitewings once per year, a full-mouth series every three to five years. Verifying the last date of service matters as much as verifying eligibility.
- Annual maximums. Most dental plans cap benefits between $1,000 and $2,000 a year. Sequencing treatment across benefit years, and telling the patient before treatment rather than after, is part of the job.
- Missing tooth clauses and waiting periods. A plan may exclude replacement of a tooth lost before coverage began, or impose a six to twelve month wait on major services. Both are discoverable in advance and expensive to discover afterward.
- Attachments not sent. Perio charting for SRP, images for endo and surgical extractions, narratives for anything unusual. A claim without them is a denial waiting to happen.
- Coordination of benefits. Dual coverage is common and frequently mishandled, with the secondary billed as primary and the claim rejected on arrival. Our guide to dental insurance claims processing explains how a dental claim moves from submission to payment.
Medical Billing for Dental Procedures
A meaningful share of dental work is billable to medical insurance, and most practices never pursue it. Surgical extractions, biopsies, treatment following trauma, certain implant cases, TMJ evaluation and treatment, and oral appliances for obstructive sleep apnea can all be medically billable when documentation supports medical necessity.
This matters especially in Florida, where a large retiree population carries strong medical coverage alongside dental plans with low annual maximums. Billing the medical plan where appropriate means treatment that would otherwise exhaust a $1,500 dental maximum, or be declined by the patient on cost, becomes affordable. We handle cross-coding, medical necessity narratives and the different claim format medical payers require. Oral surgery practices, which bill medical plans regularly, can see our oral surgery billing services.
The Florida Dental Payer Landscape
Florida dental practices bill a distinctive mix. On the commercial side, Delta Dental, Florida Blue, Cigna, MetLife, Aetna, Guardian, Humana and United Concordia cover most of the market, with a long tail of discount and employer plans that behave differently from true insurance and need to be identified before treatment.
Florida Medicaid dental for children is delivered through statewide dental plans such as DentaQuest, MCNA Dental and Liberty Dental, each with its own authorization requirements and enrollment process. Adult dental coverage under Florida Medicaid is considerably more limited than children’s, which makes verifying the specific plan and the patient’s age category essential rather than optional.
Medicare does not cover routine dental, but many Medicare Advantage plans in Florida include a dental benefit — often with a fixed allowance, a restricted network and rules that look nothing like commercial dental insurance. Given Florida’s retiree population, these plans represent a large and frequently mishandled share of dental claims.
Why Florida Dental Practices Outsource Billing
In most practices, insurance work lands on whoever is at the front desk. That person is also greeting patients, answering the phone, scheduling, and collecting at checkout. Billing is the task that gets postponed, and postponed billing is the most expensive kind — claims age past filing limits, downgrades go unchallenged, and nobody notices until the aging report is unrecognizable.
Hiring a dedicated in-house biller solves that, but the fully loaded cost of one person — salary, benefits, training, software, and coverage when they are out — usually exceeds a billing service for a practice of this size. It also concentrates risk: when your one biller resigns or goes on leave, your revenue cycle stops with them.
Outsourcing gives you a team that does only this, stays current on payer rules, and does not get pulled away by a busy waiting room. Our guide on whether outsourcing billing is a good idea covers the trade-offs honestly, including when keeping it in-house makes more sense.
The Numbers We Report
A billing service should be measurable. You should be able to see clean claim rate, days in accounts receivable, aging by bucket, and collection performance against what you are contractually owed rather than against what you billed. For dental specifically, we also watch write-off accuracy — whether adjustments posted actually match your contracted fee schedule, which is where downgrades and underpayments hide.
If a number moves the wrong way, you should hear it from us before you notice it in the bank balance.
As of 2026, our clients’ claims reach a 91% clean claim rate, and their accounts receivable average 34 days.
Credentialing for Florida Dental Practices
A dentist seeing patients before enrollment is complete is doing unbillable work. We handle CAQH setup and re-attestation, commercial panel applications, Florida Medicaid and dental plan enrollment, group versus individual contracting, and adding associates to an existing group contract.
Fee schedule review belongs in the same conversation. Practices routinely stay on PPO fee schedules years out of date without realizing what it costs per procedure, and a credentialing review is the natural moment to look at what you have actually agreed to accept. See our dental credentialing services for the full process.
Denials and Aging Accounts Receivable
Dental denials repeat, which makes them fixable. Missing attachments, frequency limits already met, a downgrade applied without challenge, a missing tooth clause, eligibility that lapsed at the start of the plan year, or a secondary payer billed as primary account for most of them.
We work denials by category rather than one at a time, appeal what should be paid, and close the upstream gap so the same denial stops arriving. For practices that come to us with a large aging report, we triage by age and payer first — balances still inside timely filing limits are where the recoverable money sits.
Serving Dental Practices Across Florida
We are based in Fort Myers and work with dental practices throughout the state — Naples, Cape Coral, Bonita Springs and Southwest Florida; Tampa, St. Petersburg, Clearwater and Sarasota; Orlando and Central Florida; Jacksonville and the First Coast; Miami, Fort Lauderdale and West Palm Beach; and Tallahassee, Gainesville and the Panhandle. Billing is handled remotely and securely, so distance is never a barrier.
We support solo practices, growing group practices adding associates, and multi-location DSO-style operations that need consistent billing across sites.
What to Look For in Florida Dental Billing Companies
Most dental billing companies in Florida offer the same list: eligibility, claims, posting, follow-up. The differences that matter are narrower. Does anyone check the EOB against your contracted fee schedule, or is a downgraded composite simply posted as paid? Are narratives, radiographs and perio charting attached before submission, or scrambled for after the denial? Who chases the patient balance once insurance has paid its share?
Cross-coding is the other place practices lose money. Many dental billing companies will not touch medical claims at all, so surgical extractions, biopsies, trauma, TMJ and sleep apnea appliances that are genuinely medically billable go unbilled year after year. We handle both, which is why it is worth asking any company you are considering whether they do. For a full list of questions to ask and red flags to watch for, see our guide to choosing a dental billing company.
Frequently Asked Questions
Do you work with our practice management software?
Usually, yes. We work inside the system your practice already uses — Dentrix, Eaglesoft, Open Dental and others — rather than forcing a migration, so your clinical records and workflow stay where they are.
Can you bill medical insurance for dental procedures?
Yes, and it is one of our specialties. Surgical extractions, biopsies, trauma cases, TMJ treatment and sleep apnea appliances are often medically billable when documentation supports medical necessity. It requires different codes, different forms and proper narratives, which we handle.
Do you handle Florida Medicaid dental plans?
Yes. Florida delivers children’s Medicaid dental through statewide dental plans, each with its own authorization rules and enrollment requirements, and enrollment must be complete before claims can be submitted.
What if our accounts receivable is already out of control?
That is a common starting point. We triage your aging by age and payer, prioritize balances still within filing limits, work those to resolution, and fix the process upstream so the backlog does not rebuild.
Will you tell patients what they owe before treatment?
That is largely what full benefit breakdowns and pre-determinations are for. Knowing the annual maximum remaining, the frequency history and whether a downgrade will apply lets your team present accurate numbers up front, which reduces both surprise balances and declined treatment plans.
Do you only work with dental practices?
No. We also handle behavioral health and psychiatric billing and general medical billing for Florida practices.
Ready to stop losing revenue to downgrades, frequency limits and unworked denials? Contact Maximum Billing, LLC or call 800-820-0364. See also our dental billing services overview and our Texas coverage.