Is Dental Insurance Watching You? AI Audits & the 2027 Implant Crown Code Change | Dr. Greg Grobmyer

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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