DENIAL REASONS AT A GLANCE
- Missing information — CARC 16: fix the field and send a corrected claim.
- Frequency or benefit limits — CARC 151, CARC 119, D1110, D0120 / D0150, D4910.
- Wrong payer or coordination of benefits — CARC 109, CARC 22.
- Authorization or filing deadline — CARC 197, CARC 29.
- Not covered or not necessary — CARC 96, CARC 50, D2740 / D2750, D2950, D4341 / D4342.
- Fee schedule — CARC 45.
- Duplicate claim — CARC 18.
Know the code and need the words? Use the dental claim appeal letter template. Wondering about timing? Read how long a dental claim appeal takes.
CARC / CO — CLAIM ADJUSTMENT REASON CODES
CARC 16 · CO-16
Claim lacks information
The most common dental denial — and the most misread. It's not a rejection; it's "we need more information." Read the paired RARC, fix the one field, resubmit as a corrected claim.
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CARC 197 · CO-197
Precertification / authorization absent
The service required prior authorization that wasn't obtained or wasn't on file. Often recoverable with a retro-auth or by proving the auth existed — before timely filing runs out.
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CARC 29 · CO-29
Timely filing limit expired
The "rotting money" denial — the claim was filed past the payer's window. Recoverable more often than offices think, with proof of timely submission or a valid exception.
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CARC 45
Charge exceeds the fee schedule
The billed amount is above the allowed maximum. Knowing which part is a genuine contractual write-off and which is recoverable is where practices leave money on the table.
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CARC 96 · CO-96
Non-covered charge
Read as "final" by most offices — but "non-covered" often means a documentation or coding gap, or the wrong benefit, not a true exclusion. Frequently overturnable.
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CARC 109
Not covered by this payer
Usually a routing problem, not a coverage problem — the claim went to the wrong payer or the coordination-of-benefits order is off. Send it to the right plan and it pays.
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CARC 50
Not deemed a medical necessity
The documentation didn't establish necessity — often a narrative or radiograph gap, not a real "no." Frequently the trigger to bill medically, where the real money is.
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CARC 18
Duplicate claim / service
A real duplicate is a non-issue — but bilateral, multi-visit, and same-day procedures get falsely flagged as duplicates constantly. The right modifier or documentation unlocks the payment.
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CDT — PROCEDURE-SPECIFIC DENIALS
CDT D2950
Core buildup denied with a crown
The classic bundling quirk — buildups get denied as included in the crown unless the documentation shows they were medically necessary. The one line that gets it paid.
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CDT D2740 · D2750
Crown denials (material cross-coding)
A top denial cause: the crown material billed doesn't match what the payer covers for that tooth, or the documentation doesn't justify the restoration. What turns it over.
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CDT D4341 · D4342
Scaling & root planing (SRP) denied
Denied for insufficient documentation — the perio chart, probing depths, and bone-loss evidence the payer requires. Attach the right proof and it's routinely recoverable.
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COVERAGE & FREQUENCY LIMITS
CARC 151
Too many services (frequency)
The payer says the documentation doesn't support this many services — cleanings, exams, x-rays, perio maintenance past the plan's frequency. Often recoverable with the right dates and medical need.
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CARC 119
Benefit maximum reached
The annual max is spent. This one is usually a real cap, not a fixable error — so the win is planning: stage treatment into the next benefit year, and check the max wasn't miscalculated.
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CDT D4910
Perio maintenance denied for frequency
The plan limits how often it covers perio maintenance — and often tries to downgrade it to a regular cleaning. The perio history and interval documentation are what hold the D4910.
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CDT D0120 · D0150
Oral exam denied for frequency
Periodic and comprehensive exams hit plan frequency caps (usually 1–2 a year), plus per-provider rules on D0150. Knowing which exam code applies is often the whole fix.
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CDT D1110
Adult cleaning denied for frequency
The plan's cleaning limit (usually 2 a year) — and prophy shares that limit with perio maintenance. A legitimate third cleaning has a path; knowing it recovers the visit.
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CARC 22
Covered by another payer (COB)
Not a real denial — the patient has two plans and this one isn't primary. Identify the primary, get its EOB, and resubmit to the secondary. Pure routing money.
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APPEAL TIMELINE
How long does a dental claim appeal take?
Two clocks run on a denied claim: your deadline to file and the payer's window to answer. How to read both, and when it is a corrected claim instead.
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DON'T DECODE THEM ONE AT A TIME
Text us the denial and we'll tell you — free — exactly what turns it over.
Send a photo of the EOB. You'll get back what the code means, whether it's winnable, and what recovers it. If it's worth pursuing, the rail files it.
TEXT A PHOTO OF THE EOB TO 510·401·3633 — FREE AUDIT BACK