Wave PointThe claim that was going to be denied
Most denials are decided the moment a procedure is coded, not three weeks later when the carrier writes back. This is one claim moving through a practice with the assistant watching.
- Procedure
- D2740
- Tooth
- 19
- Billed
- $1,240.00
- Payer
- Delta PPO
- Provider
- Okafor
- ✓ Eligibility active on Delta Dental PPO, verified today
- ✓ Annual maximum $1,500.00, $840.00 still available
- ! Crown on tooth 19 paid 2024-03-11 — inside this plan’s five-year frequency limit
- ! No narrative attached, and D2740 requires one for this payer
- ✓ Narrative drafted from the clinical note and attached
- ✓ Bitewing from 2026-09-08 pulled from the chart and attached
- With Wave Point
- paid Day 12, $992.00
- Without
- denied Day 24, paid Day 54 only if someone appeals
One of 38 claims this week. Nobody on the practice’s team opened it.
An illustration, not a client result. Built on Wave Point’s synthetic dental billing dataset — 20 offices and 50,760 records generated for testing, containing no patient data.
The animation shows a crown claim for $1,240.00 being checked at 4:10 pm on the day of the appointment. Coverage is confirmed, two problems are found — a prior crown inside the frequency limit and a missing narrative — giving an 82% denial risk. Both are corrected and the claim is submitted at 4:12 pm, then paid on day 12. Every fact it shows is written out below.
The same four minutes, written out
Nothing here needs a person to be available, to remember a plan rule, or to be on hold when the carrier picks up. It runs on every claim, including the ones that look fine.
The practice’s software does not change. The front desk does not get a new screen to check. The first time anyone hears about this claim is when it is paid.
- Day 0, 4:10 pm
The appointment closes
A crown is coded D2740 on tooth 19 and queued. In most practices this is the last time a person looks at it until the carrier responds.
- Day 0, 4:10 pm
Coverage is checked against the plan, not from memory
Eligibility is active, the annual maximum is $1,500.00, and $840.00 of it is left. A good biller confirms this too — given the time, and a carrier who answers.
- Day 0, 4:11 pm
Two problems surface that nobody would have caught today
There is a crown on tooth 19 paid in March 2024, inside this plan’s five-year frequency limit. And D2740 is going out with no narrative. Together they put the claim’s denial risk at 82%.
- Day 0, 4:12 pm
The claim is corrected before it is sent
A narrative is drafted from the clinical note and attached with the September bitewing. The claim leaves the same afternoon it was coded.
- Day 12
Paid
$992.00 posts against the claim. No follow-up, no resubmission, no phone call.
- Day 54
What would have happened instead
Denied on day 24 for the missing narrative. Reworked, appealed, and paid around day 54 — but only if somebody found the time to appeal it. Most practices do not.
Why one claim is worth this much attention
Because it is not one claim. A denial is not a lost payment — it is a payment that now costs staff time to recover, and usually does not get recovered at all.
The gap between how many denials are overturned on appeal and how few are ever appealed is the whole opportunity. It exists because appealing is slow, manual work that nobody in a twelve-person practice has time for.
- 15–20%of dental claims come back denied
- <1%of denied claims are ever appealed
- ~69%of the denials that are appealed end up being paid
Figures are published industry estimates for dental revenue cycle and small-business operations, compiled in our market analysis. Wave Point has not yet published client results, and nothing on this site is a client outcome.
What we plug into
Your practice management system stays exactly where it is. We read from it and write back to it the way your staff already do — Open Dental, Dentrix, Eaglesoft, or whatever you run.
Same for your clearinghouse, your imaging, and the spreadsheet somebody maintains by hand. If the work currently passes through it, we work with it.
What we would look at first
Denial risk before submission. Patient balances heading past 90 days. Eligibility and benefits verification ahead of the appointment. Which one we start with depends on what your numbers say in the discovery call — not on what we happen to have built already.
Bring us your denial report
Thirty minutes, and we will tell you which of your denials were predictable. If the answer is “not many”, that is a useful thing to know and it costs you nothing.