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Is dental insurance watching you? Insurers now use AI to track every claim you send, and if your numbers stand out from other dentists near you, you may get a letter in the mail. Dr. Greg Grobmyer explains what triggers those audit letters, why insurers quietly give every office a grade, and the CDT change coming January 1 that affects almost every office that restores implants, even though it isn't on the official list of changes.

In this episode:
– AI audits: why being a statistical "outlier" gets you a letter
– In network or out, they're still watching your claims
– Insurers grade your office, and what lowers your grade
– The implant crown change on January 1: abutment-supported vs. implant-supported
– Coding overdentures and hybrids, and when to use D5875 instead of a new denture
– 40 implant crown codes, not one
– Common coding errors: closing an endo access through a crown, and what really counts as a surgical extraction
– Why every evaluation needs a documented oral cancer screening
– Non-covered services laws, and why about half your plans (self-funded ERISA plans) don't follow them
– Why perio claims get denied, and codes you may be missing like D0160

📰 Plus dental news: Align names a new CEO, the 3Shape antitrust case against Align is revived, and a new False Claims Act self-disclosure window for offices that bill Medicaid, CHIP or Medicare (Oct 22, 2026 to Apr 22, 2027). Check your team against the OIG exclusion list: https://oig.hhs.gov/exclusions/

Dr. Greg Grobmyer is a dentist who left clinical practice after a cancer battle in his 30s and now teaches dental coding full time. He worked side by side with the late Dr. Charles Blair for many years, co-writes the Dental Coding with Confidence manual, attends the ADA's Code Maintenance Committee meetings, and consults and speaks nationally. Find his resources at https://dentalcoding.com

This is general information, not legal advice. Talk to a dental attorney about your own situation.

Chapters:
0:00 Intro
3:51 Mercury in retrograde and your patients
7:32 "Removing the patient from the tooth"
9:49 Why "easy" fillings and extractions aren't easy
12:33 News: Align's new CEO and the 3Shape antitrust case
14:49 News: the False Claims Act self-disclosure window
20:20 Check the OIG exclusion list
22:14 Greg's acting and stand-up past
23:17 Meet Dr. Greg Grobmyer
25:54 The CDT change nobody's talking about
26:24 CDT codes are for documentation, not billing
28:48 Abutment-supported vs. implant-supported crowns
30:08 What about screwmentable crowns?
31:25 What changes January 1
33:50 Who writes the rules in the CDT book
36:38 Coding overdentures and hybrids
39:46 Why Greg hates "deep cleaning"
40:15 40 implant crown codes, not one
42:14 Why audit letters are on the rise
43:10 AI tracks every claim: are you an outlier?
45:30 In network or out, they're watching
46:56 Insurance companies give you a grade
47:43 Where to learn CDT coding
51:19 Common errors: endo access and surgical extractions
53:50 CDT is the legal language of dentistry
56:02 Document every oral cancer evaluation
58:19 Non-covered services laws
1:00:02 Self-funded vs. fully insured plans
1:01:18 Your insurance brand may just be the administrator
1:03:44 Thank your insurance coordinator
1:04:42 Why perio claims get denied
1:05:43 Narratives for anterior PAs
1:07:03 Closing

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