What the Exception Table Does in Dentrix

The Exception Table allows you to override the standard insurance setup for specific procedure codes.

Instead of Dentrix calculating based on the default percentages in the coverage table, you’re telling it:

“For this procedure, use different rules.”

A common example is a downgrade, where insurance doesn’t pay based on the procedure you’re actually doing.

For example:

• You complete a posterior composite
• Insurance pays based on an amalgam

Without setting this up, your estimate will be off—and usually in a way that makes the patient portion higher than expected later.

Step 1: Find the Insurance Plan

Start in the Office Manager:

• Go to Maintenance
• Click Reference
• Select Insurance Maintenance

From here, you’ll see all insurance carriers and group plans in your system.

⚠️ Important:
Any changes you make here apply to every patient attached to that plan, not just one patient.

Step 2: Open Benefits & Coverage

• Select the insurance plan
• Click Benefits & Coverage
• Go to the Exceptions tab on the side

If your Exception Table is blank—that’s completely normal. A lot of offices don’t use this section, but it’s a powerful tool when you do.

Step 3: Add a New Exception

• Click the green + (Add) button

Now you’ll enter the details for the exception.

Starting Procedure

This is the procedure you are actually completing.

Example:

• Posterior composite (D2391–D2394)

You can use the dropdown to find and select the correct code range.

Step 4: Set Up a Downgrade (Example)

Let’s say the insurance downgrades composites to amalgam.

Here’s how you set that up:

• Enter your composite code range
• Add a description (ex: “Composite”)
• Select the downgrade procedure
• Choose the amalgam code Dentrix should use for estimating

You can also specify:

• Tooth type (all teeth, molars only, etc.)
• Waiting periods
• Any additional plan-specific details

Step 5: What This Actually Does

When this is set up, you’re telling Dentrix:

“If this composite is completed, don’t estimate it as a composite—estimate it as an amalgam.”

This makes a big difference because:

• Your insurance estimate becomes more realistic
• The patient portion is closer to what they’ll actually owe
• You reduce billing surprises and follow-up issues

Other Ways to Use the Exception Table

Downgrades are just one use case. You can also use the Exception Table for:

• Procedures with different frequency limitations
• Age restrictions on specific codes
• Alternate benefits scenarios
• Non-covered procedures
• Any situation where a specific code doesn’t follow the standard plan rules

Step 6: Save Your Changes

Once everything is entered:

• Click Save

That exception is now tied to the insurance plan and will apply to all patients with that coverage.

Final Thoughts

The Exception Table is one of the most underused features in Dentrix—but it can make a huge difference in how accurate your estimates are.

If your office struggles with:

• Downgrades
• Incorrect estimates
• Patient confusion around insurance

This is something worth setting up correctly.

If you’re looking for more Dentrix tutorials and step-by-step walkthroughs, check out:
👉 https://linktr.ee/dentaltechwithjaime