Specialties/Pediatric
Pediatric dental billing
Pediatric dental billing services for families, Medicaid, and CHIP.
Outsourced billing for pediatric dental practices. Age-based benefits, Medicaid and CHIP claims, children with two insurance plans, and sedation are verified and tracked inside your practice software.
What it involves
Pediatric dental billing has its own rules.
Benefits often depend on the child’s age, many patients are covered by Medicaid or CHIP, and some children are covered by more than one parent’s plan. Each of those details affects how a claim should be filed.
Accurate pediatric dental billing starts with verifying the child’s eligibility and the benefits that apply to their age. Then the claim details, including the responsible party, the coverage order, and the tooth and surface, are kept correct from the start.
What gets billed
The services behind pediatric dental claims.
Pediatric practices bill a focused set of preventive, restorative, and behavior-support codes.
Preventive care
Children’s cleanings, fluoride, and sealants, usually with age and frequency limits.
Space maintainers
Small devices that save space for adult teeth after a baby tooth is lost. Coverage and age limits vary.
Crowns for baby teeth
Ready-made metal and other crowns that protect badly damaged baby teeth.
Nerve treatment for baby teeth
Treating the inner tissue of a baby tooth to save it, which needs clear X-rays and notes.
Behavior support
Added time and support for nervous or very young patients, with strict note-keeping rules.
Sedation family (D9000 series)
Laughing gas and other calming options, with coverage that differs from plan to plan.
Where claims go wrong
Common pediatric dental billing problems, and how to prevent them.
Benefits based on age
Sealants, fluoride, and space maintainers are often limited by age or by which teeth qualify. Checking this first avoids denials.
Medicaid and CHIP rules
State programs set their own covered services, prior authorization rules, and billing steps, so each state’s rules have to be followed for accurate claims.
Two plans for one child
When parents have separate plans, the payer order must be set correctly. Many plans use the birthday rule to decide which parent’s plan pays first, and court orders can change that.
Guarantor and responsible party details
The patient is the child, but the guarantor is a parent. Estimates, statements, and claims must name the right people.
How ZenHub supports you
Pediatric billing support, from eligibility to posting.
ZenHub services that apply to a pediatric dental practice, working inside your practice software.
Insurance verification
Eligibility and age-based benefits are confirmed before the visit and entered in your practice software.
Learn about insurance verification Claims & paymentsDental billing & RCM
Claim submission, payment posting, and coordination of benefits so primary and secondary coverage are right the first time.
Learn about dental billing & rcm Payer enrollmentCredentialing
Provider credentialing, including state Medicaid enrollment, is tracked and pushed weekly.
Learn about credentialing Schedule & patientsVirtual front desk
Recall outreach, confirmations, and new patient intake keep the schedule full and families prepared.
Learn about virtual front desk Every business dayAR follow-up
Aging is worked every business day so claims keep moving.
Learn about ar follow-upWe work inside the software you already use — Open Dental, Dentrix, Eaglesoft, Curve, and more. See the software we support
Questions
Pediatric billing — common questions.
What makes pediatric dental billing different?
Benefits often depend on the child’s age, many patients have Medicaid or CHIP, and children can be covered by two parents’ plans. Each of these changes how a claim is filed.
Do you verify Medicaid and CHIP dental coverage?
Eligibility is checked before the visit, and state Medicaid enrollment for providers is part of our credentialing service.
How do you handle children covered by two insurance plans?
Coordination of benefits is part of our billing service, so primary and secondary coverage are set up correctly the first time.
Can you help with sedation and behavior management claims?
Benefits are verified before the visit so the practice knows what a plan covers, and claims are submitted with the documentation payers expect.
Keep exploring
Billing for other dental specialties.
- General Dentistry Billing Services
- Orthodontic Billing Services
- Oral Surgery Medical Billing Services
- Endodontic Billing Services
- Periodontal Billing Services
- Prosthodontic Billing Services
- Dental Anesthesia Billing Services
- Oral Medicine Billing Services
- Dental Implant Billing Services
- Cosmetic Dentistry Billing Services
- Sedation Dentistry Billing Services
Ready when you are
Let’s look at your pediatric claims.
Book a call. We will walk through your payers, your procedures, and where claims are getting stuck.
Replies within one business day · during your practice hours