Hook: You Just Pulled a Tooth… But PPOs Pulled Your Profits!
You just performed a D7280 dental code—Surgical Tooth Removal with Flap Elevation.
A patient was in pain, you did your job, and now it’s time to get PAID.
You submit the claim, expecting a decent reimbursement, but…
DENIED!
UNDERPAID!
MORE PPO HEADACHES!
Now, your front desk is:
Fighting with insurance reps.
Writing off THOUSANDS in “adjustments.”
Watching your revenue disappear into the PPO void.
Reality check: The average dental practice writes off $35,000+ per month in PPO discounts. That’s $420,000 per year—GONE.
❌ Why are you still playing this game?
✅ Over 50% of Americans don’t even 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 D7280 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. Tyler Harrison.
He was:
❌ Frustrated with insurance companies undervaluing surgical extractions.
❌ Losing thousands every month due to low PPO reimbursements.
❌ Fed up with unpredictable cash flow from insurance delays.
Then, he made ONE SIMPLE CHANGE—he stopped relying on PPOs and launched a membership plan.
Fast forward 12 months:
He dropped 3 low-paying PPOs.
His 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 D7280 Dental Code & How to Stop Losing Money on It
What is the D7280 Dental Code?
D7280 is the ADA insurance code for surgical tooth removal requiring flap elevation.
Definition:
✅ “D7280 – Surgical Access of Tooth, Removal with Flap Elevation & Debridement”
This code is used when:
✔️ A tooth is impacted, partially erupted, or difficult to extract.
✔️ A flap is needed to access the tooth for proper removal.
✔️ Additional work is required beyond a simple extraction (D7140).
BUT HERE’S THE PROBLEM:
What D7280 Should Be Worth: $350 – $600
What Most PPOs Pay: $120 – $250
That means for every 10 surgical extractions you perform, you’re losing $5,000+ per month.
The True Cost of PPO Write-Offs:
You perform 40 surgical extractions a month
PPOs underpay by $300 per case
$12,000 lost PER MONTH
$144,000 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 D7280 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 a surgical extraction (D7280) 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 impaction or need for flap elevation.
✔️ Clinical notes detailing the patient’s symptoms & required treatment.
✔️ A breakdown of why a surgical extraction was necessary over a simple extraction.
✅ 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. Harrison stopped relying on insurance patients and started offering a membership plan.
What He 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. Harrison 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.
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™
