Resources for dental offices
Writing dental narratives for insurance claims can be tricky, but they’re a key part of getting treatments approved and paid for. A clear narrative helps insurance providers understand why a procedure was necessary and how it was done. Whether you’re a dental hygienist, front office staff, or dentist, having the proper wording can save time, reduce claim denials, and make your job easier. In this article, we’ll walk you through examples of dental narratives to guide you, each one carefully crafted to show exactly what insurance providers need to see.
May 1, 2025
What Makes a Strong Dental Narrative?
Successful dental narratives follow a structured approach that leaves no room for insurance companies to question the necessity of treatment. These narratives should include:
Patient symptoms – Document specific complaints in the patient's own words. Note severity (using pain scales when applicable), frequency, and triggers. Example: "Patient reports sharp, radiating pain (7/10) when consuming cold beverages, lasting 30–45 seconds."
Clinical findings – Detail your observations using precise dental terminology. Include affected tooth surfaces, damage extent, mobility values, probing depths, or other relevant measurements. Specificity establishes necessity.
Radiographic evidence – Reference specific findings from diagnostic images. Rather than simply stating "radiographs taken," specify what those images revealed: "Periapical radiograph shows radiolucency extending to pulp chamber of tooth #19."
Diagnosis and treatment justification – Clearly state your diagnosis using appropriate CDT codes and explain why the recommended treatment is necessary. Referring to dental treatment plan examples can help you address why a less expensive or invasive alternative wouldn't work for this specific case.
Existing restorative work – Document relevant previous treatments that impact your current diagnosis and plan. Note failing restorations, recurrent decay, or complications from prior procedures.
Supporting documentation – Reference attachments that back up your findings, such as radiographs, intraoral photographs, or periodontal charts.
Many dental professionals find the SOAP notes for dentists format works well for organizing narratives:
Subjective: Patient's reported symptoms and history
Objective: Clinical and radiographic findings
Assessment: Diagnosis and severity assessment
Plan: Recommended treatment and justification
The best narratives strike a balance between comprehensive detail and concise delivery, using professional terminology while clearly demonstrating medical necessity.
13 Examples of Dental Narratives for Insurance Providers
To help you understand how to craft effective narratives, here are 15 examples of dental narratives for insurance that you can reference:
Crowns
Example 1: Fractured tooth with existing restoration
"Patient presents with spontaneous pain (8/10) in lower right quadrant, exacerbated by chewing and temperature changes. Examination reveals tooth #30 with fractured distolingual cusp extending subgingivally with recurrent decay beneath existing MOD amalgam restoration. Radiographic evaluation confirms decay in close proximity to pulp chamber. Cold testing elicits prolonged, severe response. Due to extensive loss of tooth structure (>60%) and high risk of pulpal involvement, a full-coverage crown is necessary to restore function and prevent further breakdown. A direct restoration would not provide adequate protection against fracture given the remaining tooth structure."
Example 2: Crown for endodontically treated tooth
"Tooth #14 received endodontic therapy three weeks ago due to irreversible pulpitis and apical periodontitis. Pre-operative assessment shows loss of mesial and distal marginal ridges with undermined cusps following access preparation and removal of extensive carious lesion. Radiographs confirm successful endodontic treatment with adequate obturation. Full-coverage crown is necessary to protect remaining tooth structure from fracture, as endodontically treated posterior teeth have significantly higher fracture rates without cuspal coverage. Alternative treatment with large composite would leave weakened cusps unsupported and at high risk for catastrophic fracture."
Bridges
Example 1: Three-unit bridge
"Patient presents with missing tooth #19, extracted 2 months ago due to vertical root fracture. Adjacent teeth #18 and #20 have existing crowns with good structural integrity but show signs of mesial and distal drift respectively, reducing the edentulous space. Periapical radiographs reveal adequate bone support for abutment teeth. Patient is not a candidate for implant due to insufficient buccolingual width of the ridge (4mm) as measured on CBCT. A three-unit bridge is medically necessary to restore function, prevent further migration of adjacent teeth, and address patient's difficulty with mastication."
Example 2: Maryland bridge for anterior space
"Patient presents with congenitally missing lateral incisor #7. Examination shows adequate space maintenance with healthy adjacent teeth #6 and #8 having minimal restorations. Patient reports social anxiety and difficulty with speech due to the edentulous space. Conservative preparation Maryland bridge is recommended as patient declined orthodontic treatment and bone mapping indicates insufficient bone volume for implant placement without extensive grafting. Patient is 22 years old and financially unable to pursue implant therapy at this time. Maryland bridge will restore aesthetics and function while preserving tooth structure of abutments."
Root Canal Therapy
Example 1: Symptomatic irreversible pulpitis
"Patient reports severe, spontaneous throbbing pain (9/10) in lower left quadrant for past 48 hours, worsening at night and unresponsive to OTC analgesics. Clinical examination of tooth #19 reveals deep occlusal caries with pulpal exposure. Tooth is extremely sensitive to cold with lingering pain (45+ seconds) and exhibits sharp response to percussion. Periapical radiograph shows deep carious lesion approximating pulp chamber with widening of periodontal ligament space. Diagnosis: symptomatic irreversible pulpitis with symptomatic apical periodontitis. Root canal therapy is necessary to eliminate infection, relieve pain, and preserve natural tooth structure."
Example 2: Asymptomatic pulpal necrosis
"Routine radiographic examination revealed large periapical radiolucency (8mm x 6mm) associated with tooth #9. Patient reports no symptoms but notes history of trauma to anterior teeth approximately 8 years ago. Clinical testing reveals no response to cold or electric pulp testing. Tooth is not tender to percussion or palpation but exhibits slight discoloration compared to adjacent teeth. Diagnosis: pulpal necrosis with asymptomatic apical periodontitis. Root canal therapy is necessary to eliminate periapical infection and preserve natural tooth, preventing potential future abscess formation, pain, and more invasive treatments."
Extractions
Example 1: Impacted third molar
"Patient presents with recurrent pericoronitis associated with partially erupted tooth #32. Examination reveals inflamed, erythematous operculum with purulent discharge upon palpation. Patient reports three episodes in past 6 months, most recent requiring antibiotic therapy. Panoramic radiograph shows mesioangular impaction with crown positioned against distal root of second molar creating food trap and periodontal defect on distal of #31. CBCT confirms intimate relationship with inferior alveolar canal. Extraction is necessary due to recurrent infection, risk of damage to adjacent tooth, and inability to maintain proper hygiene in the area."
Example 2: Non-restorable tooth
"Tooth #14 presents with extensive carious destruction involving >80% of coronal structure. Remaining cusps are undermined and buccal wall has fractured to gumline. Periodontal probing reveals 5-7mm pockets circumferentially. Mobility class II observed. Periapical radiograph shows extensive bone loss in furcation area and periapical radiolucency on both buccal and palatal roots. Patient reports intermittent dull pain and occasional purulent discharge. Tooth is deemed non-restorable due to insufficient remaining structure for crown, advanced periodontal involvement, and periapical pathology. Extraction is necessary to eliminate infection and allow for future prosthetic replacement."
Scaling and Root Planing
Example 1: Localized moderate to severe periodontitis
"Patient presents with generalized bleeding on probing and localized moderate to severe periodontitis in lower right quadrant. Probing depths range from 5-7mm on teeth #27-31 with 1-2mm of attachment loss. Moderate horizontal bone loss evident on radiographs, particularly in furcation area of #30. Class I furcation involvement noted on #30. Patient reports no pain but occasional bleeding when brushing. Significant subgingival calculus detected during examination. Quadrant scaling and root planing is necessary to remove subgingival deposits, reduce inflammation, prevent disease progression, and improve tissue health before initiating restorative treatment on tooth #30."
Example 2: Generalized moderate periodontitis
"Comprehensive periodontal examination reveals generalized moderate periodontitis with probing depths of 4-6mm affecting >30% of sites. Bleeding on probing present at 65% of sites. Radiographic evaluation shows generalized horizontal bone loss ranging from 3-4mm (30% of root length). Heavy subgingival calculus detected throughout, with supragingival calculus visible on lingual surfaces of mandibular anteriors and buccal surfaces of maxillary molars adjacent to Stensen's duct. Patient reports halitosis and 'shifting' of teeth. Full-mouth scaling and root planing (four quadrants) is medically necessary to control active periodontal infection, prevent further attachment loss, and establish periodontal health."
Other Procedures
Example 1: Occlusal guard for bruxism
"Patient presents with complaints of morning headaches, jaw soreness, and dental sensitivity. Clinical examination reveals wear facets on posterior teeth with enamel thinning on occlusal surfaces of molars and incisal edges of anteriors. Multiple abfraction lesions present on buccal surfaces of premolars. Tenderness noted upon palpation of masseter and temporal muscles bilaterally. Panoramic radiograph shows widened periodontal ligament space on multiple teeth. Diagnosis: nocturnal bruxism with secondary occlusal trauma. Occlusal guard is necessary to prevent further destruction of tooth structure, alleviate muscle pain, and protect recent restorative work on teeth #8, #9, and #30."
Example 2: Bone graft for extraction site
"Following atraumatic extraction of tooth #5 due to vertical root fracture, significant (>50%) buccal plate dehiscence was noted. Patient plans future implant replacement. Without grafting, ridge width measurement at crest is only 4mm with expected further resorption during healing. Socket preservation bone graft is necessary to maintain ridge dimensions, prevent significant collapse of buccal contour, and ensure adequate bone volume for future implant placement. CBCT analysis confirms 7mm is needed for appropriate implant positioning. Mineralized freeze-dried bone allograft with resorbable collagen membrane was placed to support bone regeneration."
Example 3: Buildup prior to crown
"Tooth #19 requires full coverage crown due to extensive MOD carious lesion and fracture of distolingual cusp. Following caries removal, less than 50% of coronal structure remains with undermined mesial and distal walls. Remaining walls measure less than 2mm in thickness. Core buildup with composite resin is necessary to establish adequate retention and resistance form for the crown preparation. Without buildup, insufficient tooth structure remains to support long-term restoration. Buildup will provide necessary strength and support to prevent fracture of remaining tooth structure and ensure crown longevity."
Common Mistakes to Avoid in Dental Narratives
Specific errors in narrative writing frequently lead to claim denials.
Insufficient information – Vague descriptions fail to establish medical necessity. Simply writing "Patient needs a crown on tooth #30" without documenting the extent of decay, fractures, or failed restorations gives insurers an easy reason to deny. Always include specific measurements, clinical observations, and patient symptoms.
Over-reliance on templates – While templates provide structure, copying the same narrative across multiple patients raises red flags during insurance audits. Each narrative must reflect that individual patient's unique situation. Insurance companies increasingly use software to detect patterns in narrative language that suggest templated responses.
Missing or incorrect supporting documentation – Not including the requisite radiographs and photographs that support your narrative seriously weakens your case. Similarly, using incorrect CDT codes that don't align with your narrative creates confusion and suspicion. Double-check that you've properly uploaded attachments and that the codes accurately reflect the treatment provided.
Failure to address common denial reasons – Think like an insurance reviewer to strengthen your case. When documenting crown necessity, explicitly address why a less expensive restoration wouldn't suffice.
Poor organization and presentation – Disorganized content with grammatical errors, abbreviations, and unprofessional language undermines your credibility. Insurance reviewers might question your clinical work if your documentation appears careless or unprofessional.
Consider this example: a claim for a three-surface composite on tooth #30 was denied. The original narrative stated only: "Large decay on molar, filled with composite."
After resubmission with "Extensive carious lesion involving mesial, occlusal, and distal surfaces of tooth #30 with radiographic evidence of proximal decay extending into dentin. Patient reported sensitivity to cold and sweets. Conservative restoration chosen to preserve remaining healthy tooth structure," the claim was approved.
Tips for Writing Successful Dental Narratives
To boost your insurance approval rates, try these proven techniques:
Personalization – Create a unique narrative for each patient by including their specific symptoms, history, and your clinical findings. This specificity helps with insurance approval and creates a better patient record.
Constructive communication and personalization can also improve dental case acceptance, leading to better outcomes for both patients and your practice.
Clarity and concision – Cut redundancies while keeping all critical details. Insurance reviewers handle hundreds of claims daily, so clear, direct language will help your case stand out better than lengthy descriptions. Aim for 3–7 sentences that cover all necessary elements.
Professional language – Use standard dental terminology consistently. Instead of "tooth had a hole," write "tooth #19 presents with occlusal carious lesion extending into dentin." Professional terminology builds credibility and demonstrates your clinical expertise.
Supporting documentation – Add relevant diagnostic evidence, such as bitewing radiographs for interproximal decay, periapical radiographs for endodontic conditions, and intraoral photographs for visible fractures or lesions. Combined with thorough dental insurance verification, this helps support your claims.
Highlighting medical necessity – Connect your findings directly to your treatment recommendation. Phrases like "necessary due to" and "required because" create clear links between the condition and your solution. Always explain why conservative alternatives wouldn't adequately fix the problem.
Technology solutions – Use practice management software with built-in narrative capabilities. Dental Intelligence offers smart narrative generation, while AI tools based on GPT models can help you craft comprehensive narratives when given clinical findings.
Staff training – Invest in regular training for team members who write narratives. The American Association of Dental Office Management offers resources specifically designed to improve insurance narratives and documentation skills.
The Strategic Value of Mastering Dental Narratives
Writing thorough dental narratives is important for securing insurance approvals and ensuring timely reimbursements. By focusing on clear, concise, and personalized documentation, you can reduce claim denials and improve your practice's operations.
However, even with well-crafted narratives, staffing challenges can hinder your practice's efficiency. That's where Teero can assist. Teero connects dental offices with qualified, vetted hygienists, simplifying the hiring process and allowing you to focus on patient care. Our user-friendly platform makes finding the right staff easy.