Are You Sick of PPOs Controlling Your Profits?
Let’s talk about D0230—Periapical X-Rays, Additional Films.
Every day, you take X-rays to diagnose issues and create treatment plans.
You bill insurance… and then…
DENIED!
Underpaid!
Another PPO nightmare.
Meanwhile, your front desk is buried in insurance disputes, phone calls, and paperwork.
Reality check: The average dental practice writes off $35,000+ per month in PPO discounts. That’s $420,000 per year—GONE.
Here’s the truth:
✅ Over 50% of Americans don’t have dental insurance.
✅ Membership patients accept treatment 2X-4X more than PPO patients.
✅ You can build predictable recurring revenue (MRR & ARR) with a membership plan.
In this guide, you’ll learn:
✅ What the D0230 dental code is & how to appeal a denial.
✅ Why a membership plan is the best alternative to PPOs.
✅ How BoomCloud™ helps practices generate predictable revenue & happier patients.
Let’s go.
Story: How One Dentist Ditched PPOs & Added $500K in Recurring Revenue
Meet Dr. Emily Carter.
She was:
❌ Drowning in PPO write-offs.
❌ Losing thousands every month due to low reimbursements.
❌ Frustrated with insurance denials on simple procedures (D0230).
Then, she made ONE SIMPLE CHANGE—she stopped relying on PPOs and launched a membership plan.
Fast forward 12 months:
She dropped 3 low-paying PPOs.
Her practice added $42,000/month in predictable recurring revenue.
Case acceptance skyrocketed (because patients had a simple way to pay).
That’s the power of saying goodbye to PPOs & embracing memberships.
What is the D0230 Dental Code & How to Stop Losing Money on It
What is the D0230 Dental Code?
D0230 is the ADA insurance code for an additional periapical X-ray.
Definition:
✅ “D0230 – Periapical X-ray, additional film, used to assess individual tooth health beyond the initial film.”
It’s a critical diagnostic tool, often used in root canals, extractions, and deep infections.
BUT HERE’S THE PROBLEM:
What D0230 Should Be Worth: $25 – $50
What Most PPOs Pay: $8 – $15
That means for every 100 D0230 X-rays you take, you’re losing $1,500+ per month.
The True Cost of PPO Write-Offs:
You take 300 periapical X-rays a month
PPOs underpay by $20 per case
$6,000 lost PER MONTH
$72,000 PER YEAR—GONE!
So, what’s the fix? Stop relying on PPOs & start offering a membership plan.
Why Membership Plans Are Better Than PPOs
RULE #2: Membership patients don’t need insurance. They just say YES.
How a Dental Membership Plan Works:
✅ Patients pay a low monthly or annual fee for preventive care.
✅ They get exclusive discounts on additional treatments.
✅ You generate predictable recurring revenue (MRR).
Why This Works:
✔️ Membership patients spend 2X-4X more than PPO patients.
✔️ Case acceptance skyrockets (because cost isn’t a barrier).
✔️ You create LOYALTY & RETENTION.
Want to launch your membership plan & ditch PPOs? Check out BoomCloud™
How to Appeal a Denied D0230 Claim (Because Insurance is the Worst)
Follow these steps to fight a denial:
✅ Step 1: Send a Strong, Professional Appeal Letter
Subject: Appeal for Claim Denial – [Patient Name, Date of Service, Claim Number]
To Whom It May Concern,
I am writing to formally appeal the denial of claim #[CLAIM NUMBER] for [PATIENT NAME], who received an additional periapical X-ray (D0230) in my office on [DATE OF SERVICE].
The procedure was medically necessary and aligns with ADA & standard dental care protocols.
✅ Step 2: Provide Clinical Justification
RULE #1: PPOs love denying claims due to “lack of medical necessity.”
What to Include:
✔️ X-rays showing the tooth’s condition.
✔️ Clinical notes detailing symptoms & patient discomfort.
✔️ A breakdown of why the X-ray was necessary.
✅ Step 3: Demand a Re-Evaluation & Set a Deadline
Insurance companies stall to avoid paying.
I request an immediate re-evaluation of this claim. A response is expected within 30 days of this letter’s receipt.
Please confirm receipt of this appeal and provide a timeline for resolution. I am available for further discussion at [Your Contact Information].
Sincerely,
[Your Name, Your Dental Practice]
Want to STOP relying on insurance & start getting paid what you’re worth? Check out BoomCloud™
How BoomCloud™ Helped One Practice Scale to $500K in Recurring Revenue
Dr. Carter stopped relying on insurance patients and started offering a membership plan.
What She Did:
✔️ Launched a BoomCloud™ membership plan.
✔️ Used social media & SEO to attract high-value patients.
✔️ Implemented AI booking & same-day treatment for convenience.
Results in 12 Months:
1,800 patients joined the membership program.
MRR hit $42,000/month.
ARR surpassed $504,000/year.
Now, Dr. Carter has predictable revenue, loyal patients, and NO PPO headaches.
Want the same results? Check out BoomCloud™
Final Thoughts: Stop Playing the PPO Game & Take Control of Your Practice
The biggest mistake dentists make? Relying on PPOs instead of BUILDING RECURRING REVENUE.
Here’s the winning formula:
Step 1: Appeal denials with STRONG documentation.
Step 2: Offer a membership plan to reduce insurance reliance.
Step 3: Use BoomCloud™ to automate memberships & grow predictable revenue.
More patients. More revenue. Less stress.
Ready to build a membership plan that scales? Check out BoomCloud™ and start making your practice insurance-free.
