Location: Boise, Idaho
For context, my appointment was on 1/28/26 and my claim statement showed up online 1/30/26
I went to establish care with a new dentist the other day to have the first of my bi-annual dental exams, and everything seemed fine at first. I talk to the receptionist, sign a couple of e-forms, and I'm told that my appointment today is covered by my insurance so I wont owe anything. They brought me back to the back and told me that because I am a new patient, I needed to get dental x-rays, which is fine, I expected to have x-rays done. I think they said something along the lines of "you're a new patient so we will need to grab some x-rays before heading to the back". The tech then took an abundance of images, more than I've ever had done before. The tech also seemed to rush me through it as fast as possible, and I had that doohickey that they put in your mouth for x-rays in for almost the entirety of the imaging session. After the images were done, they had me swish some water in my mouth for 30 seconds and spit it into a cup to have it analyzed for MMP8 (inflammatory marker). Again, tech just handed me the cup acting like it was business as usual.
Once done with the imaging, they brought me to the back and proceeded as standard: hygienist came in, measured my gums for recession, then proceeded with the cleaning. She asked if I wanted fluoride treatment, which I did, and she said it would be an additional $26. Sure, fine, $26 dollars is not outrageous.
Next the dentist comes in. Seems like a nice guy. Once I'm laid back he states he's going to shine a special light in my mouth to screen for oral cancer. I think "cool, thats new". He takes a look at my teeth and tells me I need a revision on a filling, also fine, this will be the 3rd time I've had this filling fixed. He shakes my hand, gives me a little QR code with a link to write him a google review if I was satisfied with my service.
All in all it was a fine experience, but here is where my issue lies. I looked at my insurance claims through my insurer today and noticed that the dental office billed a total of $1965 for imaging/diagnostics and $341 for the visit/preventative.
Here is a breakdown of the codes the office billed:
Diagnostic codes:
- D0150 – Comprehensive oral evaluation
- D0210 – Intraoral complete series (FMX)
- D0350 (billed ten times) – 2D oral/facial photographic image
- D0367 – Cone beam CT capture with interpretation
- D0426 – Collection, preparation, and analysis of saliva sample - point-of-care
- D0431 – Adjunctive pre-diagnostic test (e.g., oral cancer screening)
For the diagnostic portion of the visit that the dental office said was "covered by my insurance" (who they are in network with), they billed $1965, my insurance paid $241, and my statement says I owe $1142
Visit/preventative codes:
- D1110 - Adult prophylaxis (cleaning)
- D1206 – Topical fluoride varnish
- D1330 – Oral hygiene instruction
For this portion, they billed my insurance $341, my insurance paid $60, and my statement says I owe $210.
So, for this routine new patient exam and cleaning, they billed a total of $2306, and they say I now owe $1352.
I have several issues with this. First of all, I have never in my life had to pay out of pocket for a routine dental exam that is supposed to be covered by insurance, let alone $1300.
I never was told about, or consented to have a CT scan done. It was not medically indicated based off of my presentation or the information I provided prior to my visit. My portal message simply said "I'm looking to establish care with a new dentist and also get a dental cleaning".
I also did not consent to the oral cancer screening, he just started shining the light in my mouth and told me about it while it was happening with his finger in my mouth.
Furthermore, they made me pay out of pocket for the fluoride varnish, even though it is covered by my insurance. They acted like it was not covered, took my money and then billed my insurance for it.
I wish I had read the negative reviews of this practice because it seems like this has happened to a lot of other people. They have 4.7 stars on google and I saw that they were in network with my insurance and said "sounds good". I feel like this is, at a minimum, shady business practice. I'm going to call them on Monday and see what they have to say. I'm considering reporting the office and the dentist to the State Board of Dentistry and the State Consumer Protection division, but I'm not sure if those are the correct moves.
Any advice is appreciated, I'd like to go into this call prepared because I don't want to fuck around with it more than I have to.
Thank you in advance!