Dental Billing Services in Pennsylvania

Pennsylvania dental offices juggle commercial PPO networks and, for many practices, Medical Assistance, the state’s Medicaid program, with its own enrollment rules for dentists and orthodontists. Maximum Billing provides dental billing services for Pennsylvania practices: benefit breakdowns, CDT coding, claims with attachments, write-off review, appeals, and steady follow-up on every open claim, all inside your own software.

Schedule a consultation or call 800-820-0364.

Client results as of 2026. Request a billing review.

What We Handle for Pennsylvania Dental Practices

• Benefit checks before the visit covering maximums, deductibles, frequency history, waiting periods, and missing tooth clauses.
• Coding review of CDT codes, tooth numbers, and surfaces against the chart.
• Claim submission with attachments such as X-rays, perio charts, photos, and narratives.
• Pre-determinations for major restorative and implant treatment.
• Posting and write-off review against each PPO contract.
• Appeals for denials and alternate benefit downgrades.
• Follow-up on every unpaid insurance claim.
• Medical claims for oral surgery and other dental procedures a medical plan covers.
• Clear patient statements after insurance pays.

Pennsylvania Medical Assistance for Dentists

Pennsylvania’s Department of Human Services enrolls dentists in Medical Assistance as provider type 27. Individual dentists add an anesthesia permit and a DEA certificate where they apply, and orthodontists submit an Orthodontic Education History form. Public health dental hygiene practitioners must fee assign to a dental or physician group unless they work at an FQHC. DHS’s dentist enrollment FAQ cites 30 working days for a clean application, and enrollment in Medical Assistance does not by itself place a dentist in any managed care plan’s network. Our Pennsylvania Medicaid provider enrollment guide explains the portal and the documents.

Five-Year Revalidation, Location by Location

Pennsylvania revalidates every service location every five years, and the electronic revalidation application should be filed at least 60 days before the due date. A multi-location dental group can have several dates to manage. We track them with your PPO re-credentialing so no office loses its Medical Assistance payments. See our dental credentialing services and our Pennsylvania credentialing services.

Common Revenue Leaks in Pennsylvania Dental Offices

• Fee schedules in the software that no longer match the PPO contract, so underpayments post as normal write-offs.
• Exams, cleanings, or images billed before the plan’s frequency limit resets.
• Crowns and perio treatment sent without the images or charting the plan requires.
• Downgraded posterior composites and crowns that were never appealed.
• Secondary dental or medical coverage left unbilled.
• Claims nobody follows up on until the filing limit has passed.

Practices and Software We Work With

We support general dentistry and specialty practices, including periodontics, endodontics, oral surgery, orthodontics, prosthodontics, and pediatric dentistry, from single-dentist offices to multi-location groups. We work in Eaglesoft, Dentrix, Dentrix Ascend, and Open Dental.

Choosing a Dental Billing Partner in Pennsylvania

Look for dental-specific experience, work inside your existing software, a signed Business Associate Agreement, reporting on collections, clean claim rate, and aging, and a clear explanation of what the fee covers. Our guide on how to choose a dental billing company goes through each question.

Frequently Asked Questions

What provider type do Pennsylvania dentists enroll under?

Dentists enroll in Medical Assistance as provider type 27, with an anesthesia permit and DEA certificate added where they apply.

Do orthodontists need anything extra for Pennsylvania Medical Assistance?

Yes. Orthodontists submit an Orthodontic Education History form with their enrollment.

How long does Pennsylvania dentist enrollment take?

DHS’s dentist enrollment FAQ cites 30 working days for a clean application. Plan credentialing takes additional time.

Do you work in our practice management software?

Yes. We work inside Eaglesoft, Dentrix, Dentrix Ascend, and Open Dental.

Talk to Us About Your Pennsylvania Practice

Tell us about your dentists, payers, and locations, and we will review your aging report and recent denials with you. See our dental billing services, or contact us to get started.