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March 10, 2025 · 7 min read
Dental Insurance Predetermination: Step-by-Step Guide
A practical guide to dental insurance predeterminations, the ADA form, and how to use them to lower dental costs.
What is a dental insurance predetermination?
A predetermination is a pre-treatment estimate submitted to your insurer. It confirms allowed amounts, coverage levels, and alternate benefits before you commit to treatment.
Step 1: Get the itemized CDT codes
Ask the office for every CDT code and fee. Without the full list, insurance cannot give accurate numbers.
Step 2: Request the ADA form submission
Have the office submit a predetermination with X-rays and notes. Ask for confirmation that the form went to every plan you have.
Step 3: Review allowed amounts
The response shows the allowed amount, deductibles, and any alternate benefits. This is your leverage to negotiate before treatment.
- Confirm no balance billing in writing.
- Check whether a cheaper alternate benefit applies.
- Compare primary and secondary coverage if you have two plans.
Step 4: Use the response to lower your bill
Bring the predetermination back to the office. Request adjusted fees, re-coding, or scheduling changes based on the insurer response.
Need a predetermination script?
We give you the exact wording to send to dental offices and insurers.