CDC Dental Insurance & Billing Flashcards
6 cards from real CDC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 CDC Dental Insurance & Billing flashcards as text
Which organization develops and maintains the Current Dental Terminology (CDT) code system?
Answer: American Dental Association (ADA)
The American Dental Association (ADA) owns, develops, and annually updates the CDT code system used for dental procedure reporting.
What is a predetermination in the dental insurance process?
Answer: A prior estimate of insurance benefits for planned dental treatment submitted before services are rendered
A predetermination is a voluntary submission to the insurance company before treatment begins to estimate covered benefits for proposed procedures.
What is the standard claim form used to submit dental insurance claims in the United States?
Answer: ADA Dental Claim Form
The ADA Dental Claim Form is the nationally standardized form used for submitting dental insurance claims; electronically it is transmitted as the HIPAA 837D transaction.
What is a fee schedule in the context of a participating dental insurance plan?
Answer: A predetermined list of fees the insurance plan will pay for specific dental procedures
A fee schedule is the fixed list of maximum allowed fees for each procedure that contracted dentists agree to accept as payment in full from the insurance plan.
Which CDT code represents a periodic oral evaluation for an established patient?
Answer: D0120
D0120 is the CDT code for a periodic oral evaluation—a routine recall exam for an established patient.
Which billing practice occurs when a dental office bills separately for procedures that should be submitted under a single inclusive code?
Answer: Unbundling
Unbundling is the fraudulent practice of billing separate CDT codes for components of a procedure that the payer considers included in one comprehensive code.