Dental Coding Tips: Getting Crowns, Perio & Aligners Paid | Dr. Greg Grobmyer
October 30, 2025
Why does insurance deny a crown on a cracked tooth, or a perio claim with deep pockets? Dr. Greg Grobmyer of Dr. Charles Blair & Associates explains how dental benefit plans really decide what to pay, which codes most offices miss, how insurers now use AI to read your x-rays, and the biggest 2026 CDT code changes. In this episode: - Dental insurance isn't insurance: what a defined benefit plan means - Cracked tooth syndrome, and the documentation that gets a crown paid - D0180, the comprehensive perio evaluation most offices underuse - Caries risk codes that unlock extra prophys and adult fluoride - What you can code for on clear aligner cases - How insurers use AI on claims and radiographs, and why angled bitewings get perio denied - Fee balancing: why a 3% increase isn't 3% - 2026 changes: chairside saliva testing, no more PRR, cracked tooth testing, duplicate dentures, peri-implantitis scaling and new sedation codes Plus dental news: SmileCon and the ADA's new president, the merger of the dental licensing exam boards into ADEX, and highlights of the 2026 CDT codes. Dr. Greg Grobmyer practiced dentistry for 10 years before a health issue ended his clinical career. He now writes Dental Coding with Confidence with Dr. Charles Blair & Associates, and consults and speaks nationally on coding, documentation and fees. Find his resources at dentalcoding.com. Chapters: 0:00 Intro 6:28 Practice finances, KPIs and planning your exit 10:26 Three disasters in three weeks, and why KPIs saved us 13:31 When staff costs outpace the practice 14:42 News 14:49 News: SmileCon and the ADA's new president 15:23 News: dental exam boards merge into ADEX 17:26 News: 2026 CDT code highlights 20:43 Why do dentists work for free? 22:48 Introducing Dr. Greg Grobmyer 26:52 From cancer to coding: his career pivot 27:51 Get occupation-specific disability insurance 28:53 Writing Dental Coding with Confidence 31:13 2026 code changes 31:45 D0180: the underused perio evaluation 32:34 Chairside saliva testing 33:37 Preventive resin restorations are gone 34:42 A code doesn't mean coverage 36:18 Dental insurance isn't insurance 37:51 Cracked tooth syndrome and getting crowns paid 40:53 How many patients max out their benefits? 42:16 Caries risk codes unlock more benefits 45:07 Coding clear aligner cases 49:13 How insurers use AI on claims 50:34 AI, x-rays and perio claims 52:43 Insurance companies check boxes 53:14 Revenue reviews and fee balancing 56:38 Your clinical notes are what count in an audit 57:28 He tested AI on coding questions 58:44 2026 sedation code changes 1:00:55 Scaling around implants with peri-implantitis 1:03:21 Where to find Greg 1:05:21 Pivoting when life throws a curveball 🎧 Listen to the podcast: Apple Podcasts: https://podcasts.apple.com/us/podcast/dentists-in-the-know/id1543254763 Spotify: https://open.spotify.com/show/2Elfj6LX0hCUyp0AgdTsij 📺 Make sure you subscribe to catch new episodes live every Wednesday at 8pm ET! https://www.youtube.com/@dentistsintheknow 🌟 Stay up to date on all the latest dental trends when you follow the DINKs: https://fanflet.com/dinks/social-2
