Free Dental Invoice Template

What to include on a dental invoice

• Practice and patient details
• Date of service
• Procedures (with codes if used) and fees
• Insurance or amount already paid
• Balance due and payment terms

Dental billing: procedures, codes and the insurance gap

Dental invoices are built from procedures, each with a CDT code (D-code), a fee, and a tooth/surface where relevant. The complication is insurance: the practice bills the carrier, the EOB comes back with the allowed amount and the plan’s share, and the patient invoice covers the rest — deductible, co-insurance, and anything over annual maximums. A patient statement that shows the original fee, insurance payment, adjustments, and the remaining balance line-by-line collects far better than a bare “amount due”. For uninsured patients, many practices show a courtesy discount as its own line.

Common dental fees (US, uninsured ballparks)

Regional variation is large; these are typical private-practice ranges:

• Exam + cleaning (D0120/D1110): $150–$350
• X-rays, bitewings (D0274): $50–$150
• Composite filling (D2391+): $150–$400 per tooth
• Crown (D2740): $1,000–$2,000
• Root canal, molar (D3330): $1,000–$1,800
• Extraction, simple (D7140): $150–$400

Statements that reduce front-desk friction

• List each procedure with its CDT code, tooth number and date of service
• Show insurance payments and write-off adjustments as their own lines, then the patient balance
• Collect the estimated patient portion on the day of service; invoice only the true remainder
• Offer and document payment plans on larger treatment (“$1,800 crown — 3 × $600, day/30/60”)
• Include the provider’s name and NPI on statements — some reimbursement and FSA claims require it