How to Find the Coverage Table in Dentrix

To get started:

1. Open Office Manager
2. Go to Maintenance
3. Click Reference
4. Select Insurance Maintenance

From here, find the insurance carrier and group plan you want to work on.

Once selected, click Benefits/Coverage.

On the left side, click Coverage Table.

Important: This Affects Every Patient on the Plan

Before making any changes, just keep this in mind:

Anything you enter in the coverage table applies to every patient attached to that insurance plan.

So always double check that you’re working in the correct plan before making updates.

What the Coverage Table Does

If your coverage table is blank, that’s actually very common.

A lot of offices don’t use this section at all and instead rely on the default insurance percentages.

But the coverage table allows you to:

• Control coverage by procedure code
• Customize coverage by code ranges
• Override general plan percentages when needed

Instead of Dentrix estimating based on category alone, you’re giving it specific instructions.

How to Enter Coverage Information

Inside the coverage table, you’ll see procedure code ranges grouped together.

For example:

• Diagnostic and preventive codes (often 100%)
• Basic procedures (often 80%)
• Major procedures (often 50%)

To make changes:

• Simply double-click into the coverage percentage field
• Enter the correct percentage based on the insurance plan

You can also indicate:

• Whether a deductible applies
• If a copay is required
• Whether pre-authorization is needed

This allows you to mirror the actual insurance breakdown as closely as possible.

Using a Standard Coverage Table (Quick Setup)

If you want a quick starting point, Dentrix allows you to apply a standard coverage table.

From the dropdown, you can select a default setup such as:

• 100% for preventive
• 80% for basic
• 50% for major

This will automatically populate the table, and then you can go in and adjust anything that’s specific to that plan.

How to Add Procedure-Specific Coverage

This is where the coverage table becomes really powerful.

You’re not limited to general categories—you can get very specific.

Example: Occlusal Guard Not Covered

Let’s say:

• Most basic procedures are covered at 80%
• But this specific plan does not cover occlusal guards

Here’s how to enter that:

1. Click Add
2. Enter the procedure code: D9944
3. Set the beginning and ending code to the same value (since it’s one specific procedure)
4. Add a description (optional, like “Occlusal Guard”)
5. Set coverage to 0%
6. Click Save

Now, anytime that procedure is treatment planned, Dentrix will estimate no insurance coverage, even though it’s typically considered a basic service.

Why This Matters for Treatment Planning

Without the coverage table:

• Dentrix relies on broad percentages
• It may overestimate insurance coverage
• Patients may end up with unexpected balances

With the coverage table:

• You can match the actual insurance plan details
• Estimates become more accurate
• Financial conversations become easier

Final Thoughts

The coverage table in Dentrix really helps if you want more control and more accurate insurance estimates, it makes a big difference.

You can keep it simple with standard percentages, or get as detailed as you want by entering specific procedure rules.

Either way, it gives you the ability to tailor your treatment plans to match real insurance behavior much more closely.

If you’re looking into any resources mentioned in this post or want more Dentrix tutorials, check out:
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