Teledentistry got a huge, artificial push during the pandemic emergency period and then settled into something much smaller and more useful: a way to handle a handful of visit types that do not require hands in a mouth. Most practices that tried it and quit did so because they treated it as a new revenue line instead of a scheduling and triage tool. Most practices that kept it did so because it quietly saved chair time.
This post covers what teledentistry actually is, the two CDT codes that describe it, the three regulatory questions you must answer for your own state before you offer it, and an honest list of what it does and does not do. It is educational, not legal advice. Your state dental board and a dental-specific attorney are the authorities on what you can do where you practice.
Key takeaways
- Teledentistry is a delivery method, not a procedure. The CDT code set describes it with two codes: D9995 for synchronous (live, real-time) encounters and D9996 for asynchronous (store-and-forward) encounters. Both are reported in addition to the clinical procedure codes performed, not instead of them.
- Scope, supervision, and licensure rules are set state by state. Whether a hygienist can collect records remotely, whether you can prescribe without an in-person exam, and whether you can treat a patient physically located in another state are all separate questions with different answers depending on the state.
- Payer coverage varies widely. Some plans cover the teledentistry codes, some pay only the underlying procedure, some pay nothing. Verify per plan before you build a schedule around it.
- The strongest use cases are triage of after-hours and emergency calls, post-op follow-up, clear aligner and ortho check-ins, denture and appliance issues, and pre-visit consults that shorten or prevent a wasted appointment.
- The weakest use case is anything that requires probing, percussion, transillumination, tactile caries detection, or radiographs you did not already have.
- Documentation standards do not relax because the visit is virtual. Record the modality, who was present, what was reviewed, what you concluded, and what you told the patient.
What teledentistry actually means
Teledentistry is not a type of dentistry. It is a method of delivering a service that would otherwise be delivered face to face. The distinction matters because it drives both coding and compliance: you are still performing an evaluation, a consultation, or a case assessment, and the clinical standard for that service does not change because you are on a video call.
There are two basic modes.
| Mode | What happens | Typical use |
|---|---|---|
| Synchronous (real-time) | Live two-way audio and video between the patient (or a remote team member with the patient) and the dentist | Emergency triage, post-op check, consultation, second opinion, screening before a first visit |
| Asynchronous (store-and-forward) | Photos, radiographs, intraoral scans, or a completed history are captured and transmitted, then reviewed by the dentist later | Remote hygiene screenings, image review, aligner progress checks, specialist referral review |
The CDT codes: D9995 and D9996
The ADA's CDT code set includes two teledentistry codes. Verify the current nomenclature in the CDT edition you are billing under, since descriptors are revised over time.
| Code | Describes |
|---|---|
| D9995 | Teledentistry, synchronous, real-time encounter |
| D9996 | Teledentistry, asynchronous, information stored and forwarded to dentist for subsequent review |
Three things about these codes trip people up.
They are adjunct codes. ADA guidance describes them as reported in addition to the other procedures delivered during the encounter, on a separate service line. If you perform a limited oral evaluation by video, you report the evaluation code and the teledentistry code. D9995 by itself, with no clinical service attached, is not how the codes are designed to be used.
They are reported once per date of service per patient. You do not stack them for a call that goes long or for two separate conversations on the same day.
They describe the modality, not the payment. A code existing in CDT tells you how to describe what you did. It tells you nothing about whether a plan will pay for it. Those are separate systems.
Claim mechanics. ADA guidance on documenting teledentistry events points to using the place of service code for telehealth on claims and listing the dentist's practice location as the treatment location, not where the patient happened to be sitting. Confirm the current place-of-service convention with each payer, because clearinghouse and payer edits are not uniform. Our overview of CDT code categories covers how the code set is organized more broadly.
The three regulatory questions you must answer first
Before you schedule a single virtual visit, get written answers to these three questions for your own state. All three vary, and none of them is safe to assume.
1. Licensure: where is the patient?
The general rule in US healthcare is that you must be licensed in the state where the patient is physically located at the time of the encounter, not the state where you are sitting. That means a patient who drives across a state line, or who is at a second home, or who is a college student out of state, may be outside the reach of your license even though they are your patient.
Licensure portability is slowly improving. The Dentist and Dental Hygienist Compact, which would let licensees practice in other participating states through a compact privilege, has been enacted by a growing number of states and reached activation status, but as of this writing compact privileges are not yet being issued and implementation is still in progress. Check the compact's own status page rather than relying on a news article, and do not assume your state's enactment means you can practice across a line today.
2. Scope and supervision: who can do what remotely?
This is where states differ most. Questions to answer with your board:
- Can a dental hygienist or assistant collect records at a remote site (a school, a nursing home, a mobile unit) and transmit them to you for review? Under what level of supervision?
- Does the arrangement require a prior in-person exam by you, or can the remote encounter establish the relationship?
- Are there specific record, consent, or technology requirements for teledentistry in your state's rules?
- Does your state require teledentistry-specific continuing education or registration?
3. Prescribing: can you prescribe off a virtual visit?
Prescribing rules are a separate body of law from practice-act rules, and they have their own state variation plus federal overlay for controlled substances. Some states allow a prescription to be issued after a properly conducted telehealth encounter; some require a prior in-person examination for certain drug categories. Controlled substances have their own federal framework that has been revised repeatedly in recent years. If your teledentistry use case depends on prescribing antibiotics or analgesics, resolve this specifically before you start, and confirm the current rule rather than working from a policy you remember from the emergency period.
The expensive mistake. Practices sometimes build a teledentistry program around a workflow they saw a national company use, without checking whether that company's model is legal in their state or relies on a corporate structure that is not available to a private practice. The model may depend on a specific supervision arrangement, a different state's rules, or a different license type. Copy the concept, not the compliance posture.
What teledentistry is genuinely good for
Rank use cases by one question: does the decision you need to make depend on information a camera can capture?
Emergency and after-hours triage
This is the strongest use. A patient calls at 7 p.m. with facial swelling, a lost temporary, or pain after an extraction. A five-minute video call lets you distinguish a problem that needs to be seen tonight from one that can wait until Tuesday, and lets you tell the patient which one it is with far more confidence than a phone description allows. The value is not the fee. The value is not opening the office at 9 p.m. for a lost crown, and not sending someone with a spreading infection home to wait.
Post-operative follow-up
Surgical and endodontic follow-ups that exist mainly to confirm healing is on track are frequently a five-minute conversation and a look. Converting some of those to virtual visits frees chairs without reducing care, as long as you have a clear rule for when a virtual check converts to an in-person visit.
Consultations and second opinions
Case discussions, treatment plan reviews, and referral conversations with a specialist are inherently informational. Doing them virtually often gets them scheduled, which is more than can be said for in-person consults that patients cancel.
Orthodontic and aligner progress checks
Progress monitoring between records appointments is a natural fit for asynchronous photo review with a defined capture protocol.
Pre-visit screening for new or anxious patients
A short virtual conversation before a first appointment can sort out what the patient actually wants, gather history, set expectations about cost and time, and reduce the number of new-patient slots that are used up by someone who wanted something you do not provide. This connects directly to no-show and conversion economics. See reducing no-shows for the broader picture.
Access-focused outreach
Screenings in schools, long-term care facilities, and rural sites, with a hygienist capturing records and a dentist reviewing them, are the use case that most state teledentistry statutes were actually written around. Whether your practice can do this depends entirely on your state's supervision rules.
What teledentistry is not good for
Be blunt with yourself and with patients about the limits.
| You cannot do this remotely | Why it matters |
|---|---|
| Probe and chart periodontal pockets | Perio diagnosis and staging depend on measurements no camera provides |
| Percuss, test mobility, or apply cold or electric pulp tests | Pulpal and periapical diagnosis is largely a tactile and test-based process |
| Detect interproximal caries reliably | Requires radiographs; a photo of an occlusal surface tells you very little about what is between the teeth |
| Evaluate occlusion meaningfully | Static photos misrepresent contacts and excursions |
| Complete a comprehensive oral evaluation | The service requires elements a virtual visit cannot capture; do not code a comprehensive evaluation off a video call |
| Perform an oral cancer screening to the usual standard | Palpation of nodes and floor of mouth is part of the exam |
The practical rule: a virtual visit can establish urgency, narrow a differential, and answer questions. It rarely produces a definitive diagnosis on its own, and your documentation should say so.
Payer coverage: verify, do not assume
Coverage of the teledentistry codes is a plan-by-plan question. ADA guidance itself directs practitioners to contact the patient's plan about reimbursement rather than assuming a general rule. In practice you will see all of the following:
- Plans that pay a small fee for D9995 or D9996 in addition to the underlying procedure
- Plans that pay the underlying evaluation code but treat the teledentistry code as informational with zero allowance
- Plans that do not recognize a virtual evaluation at all and deny the whole claim
- State Medicaid programs with their own teledentistry rules, sometimes broader than commercial coverage and sometimes narrower, and often with specific provider-type and site requirements
Build it into verification. Add two lines to your insurance verification worksheet: "Teledentistry codes covered? Y/N" and "Which evaluation codes are payable via teledentistry?" If your front office is verifying benefits anyway, this costs seconds. See the verification process post for how to structure that call.
If the plan does not cover it
You have three honest options: absorb the time as a practice-building cost, charge the patient a modest cash fee disclosed in advance, or do not offer the service. What you must not do is bill the visit as something it was not. If you did not perform a comprehensive evaluation, do not code one.
A hypothetical worked example
Hypothetical example. These numbers are illustrative, not survey data.
A two-doctor general practice collects $1.6 million a year and takes roughly 25 after-hours emergency calls a month. Historically, about 8 of those turned into a same-day or next-morning emergency appointment that displaced a scheduled patient, and about 6 turned out on arrival not to need treatment that day.
The practice adds a structured virtual triage step: the on-call doctor does a short video call before deciding whether to open a slot. Suppose that over three months the pattern settles at 6 in-person emergency visits a month instead of 8, and the 6 unnecessary visits drop to 2.
The direct fee revenue from teledentistry codes in this scenario might be trivial, perhaps a few hundred dollars a quarter, and some of it uncollected. The real effect is about 4 reclaimed chair hours a month and fewer displaced scheduled patients. If the practice values a restorative chair hour at roughly $450 of production, the recovered capacity is worth far more than the codes. That is the correct way to evaluate a teledentistry program: as a scheduling instrument, measured in chair time and patient retention, not as a billing line.
Technology and HIPAA
The temporary enforcement flexibility that allowed consumer video apps during the public health emergency is over. Treat teledentistry like any other system that touches protected health information.
Teledentistry technology checklist
- Platform vendor will sign a business associate agreement, and you have it on file
- Connection is encrypted in transit; recordings, if any, are encrypted at rest
- You know whether the platform stores video or images, where, and for how long
- Images and notes flow into the patient chart in your practice management system, not into a separate silo or a phone's camera roll
- Staff use practice accounts, not personal ones, with unique logins and multifactor authentication
- Patients are seen in a private space on your end; a front-desk workstation in an open area is not one
- Consent for the virtual encounter is documented, including the limits of a remote evaluation
- Your HIPAA risk analysis has been updated to include the platform
Our HIPAA security checklist and the post on dental office cybersecurity cover the surrounding infrastructure. If something goes wrong, HIPAA breach response walks through the first days.
Documentation that holds up
A virtual encounter note should let a reviewer, a board, or a defense attorney reconstruct what happened. At minimum, record:
- Modality: synchronous video, telephone only, or store-and-forward, and the platform used
- Who participated and where the patient was physically located (this is your licensure record)
- Chief complaint and history obtained
- What you actually reviewed: images submitted, prior radiographs, what you could and could not see
- Your assessment, explicitly framed as provisional where it is provisional
- Instructions given, including red-flag symptoms that should prompt an immediate in-person visit or emergency room referral
- Disposition: appointment scheduled, referral made, prescription issued, or watchful waiting with a defined recheck
- Consent documentation
Retention rules for these records follow your state's normal dental record requirements. See dental records retention.
Telephone is not video. A phone call without video is generally not a synchronous teledentistry encounter as the codes contemplate, and several payers explicitly exclude audio-only contact. Do not report D9995 for a phone call. Document phone advice as phone advice.
Setting it up without overbuilding
Teledentistry launch checklist
- Read your state practice act and board rules on teledentistry; save a dated copy
- Confirm supervision rules for any remote record collection by hygienists or assistants
- Confirm prescribing rules for virtual encounters in your state
- Confirm your malpractice carrier covers teledentistry and whether it covers patients in other states
- Pick a platform with a signed business associate agreement; prefer one integrated with your practice management software
- Write a one-page consent that names the limits of remote evaluation
- Write a triage script with explicit criteria for "come in now," "come in this week," and "watch and call if"
- Add teledentistry questions to your insurance verification workflow
- Set a cash fee for non-covered virtual visits and disclose it before the call
- Train the front desk on how a virtual visit gets scheduled, documented, and converted to an in-person visit
- Decide who is on call and how they are compensated for it
- Review the first 20 encounters as a group: what did the virtual visit change, and what did it miss?
Confirm your malpractice position in particular. Coverage for telehealth, and coverage for a patient located in a state where you are not licensed, are two different questions for your carrier. Our post on malpractice insurance for dentists covers how policy forms differ.
Where this fits in your practice
Teledentistry earns its place as a triage and follow-up tool that protects chair time and improves access for a subset of patients. It does not replace an examination, it does not generate meaningful fee revenue in most general practices, and it carries real state-level compliance obligations that you have to work out for yourself rather than borrow from a vendor's marketing page. Set it up narrowly, document carefully, and measure it in reclaimed chair hours rather than in codes billed.
Before you turn it on, confirm your state's rules with your board and your attorney, and confirm coverage with your top payers. Then start with one use case, usually emergency triage, and add a second only after the first one is running cleanly.
Related reading on ChairsideSource: AI in dentistry for the other technology decision owners are facing right now, what a dental practice website actually needs if you plan to advertise virtual visits, scheduling strategy for how emergency capacity should be built into the day, and front desk scripts for the calls that precede every virtual visit.
Educational content only. It is not legal, financial, tax, or clinical advice. Prices and ranges are approximate and vary by region, condition, and year. Verify current rules with your state dental board and qualified professionals. ChairsideSource is not affiliated with any manufacturer, the ADA, or the DAT.