The Dental Billing Podcast

Raising Perio Performance with Ed Faton RDH (The Hygiene Coach) Part Two

• Ericka Aguilar

Share episode

Got questions? Send Ericka a Text!

Stop letting a benefits table decide your standard of care. We sit down with dental billing expert Ed to tear down the fear, myths, and mixed messages that keep teams from coding honestly, educating clearly, and treating confidently. From fluoride and adult sealants to SDF that literally shows patients a visible change, we talk through how to make prevention tangible and persuasive without hiding behind “what insurance allows.”

We get real about code 4346: when a gingivitis cleaning is performed, document it, submit it, and stop defaulting to prophy because it feels safer. You’ll hear why underutilization hurts reimbursement, how to manage downgrades and co-pays with straight talk, and why transparency plus consistency builds trust faster than “people-pleasing” benefit games. Ed shares the operational fixes that work: clinicians educate and treat; the front handles money and benefits. With set protocols for LBR, LAPT, and perio maintenance, case acceptance climbs—even in tough markets.

Then we shift into leadership and metrics. Treat your column like a business and aim for 3.5x your daily pay to sustain raises, instruments, and training. Design intentional schedules that blend perio maintenance, SRP, re-evals, and preventive services. Train smarter: integrate lasers and SDF to control disease and show results. We highlight common myths from seminars and social media that sabotage coding and scheduling, and we replace them with clear steps, aligned scripts, and practical KPIs, including 4346 utilization, perio maintenance rates, and photo documentation.

If you want ethical documentation, stronger production, and healthier patients without awkward fee chats, this conversation will become your playbook. Subscribe, share this with your team, and leave a quick review telling us the one change you’ll implement this week.

Schedule a demo with MaxAssist to unlock scheduleing potential here:

https://maxassist.com/book-a-demo-fortune-billing/


Join The Biller Acceleration Mentorship Wait List Here: (Only 5 Spots Left in 2025!!)

https://linktr.ee/dental_billing_coach

Would you like to set-up a billing consultation with Ericka? She would love the opportunity to discuss your billing questions and see how Fortune Billing Solutions may help you.

Email Ericka:
ericka@dentalbillingdoneright.com

Email Jen:

jen@dentalbillingdoneright.com

Email Ed:

ed@dentalbillingdoneright.com

Schedule a call with Ericka:

https://calendly.com/ericka-dentalbillingdoneright/30min


Perio performance formula:

(D4341+D4342+D4346+D4355+D4910)/(D4341+D4342+D4346+D4355+D4910+D1110)


Delta Dental Locum Tenens Form:

https://www1.deltadentalins.com/content/dam/ddins/en/pdf/dentists/locum-tenens-form.pdf





SPEAKER_00:

Hygienist, I tell them from the get-go, hey, we don't let insurance dictate what we are doing. Guess what? There's a reason why that they did it once, and that I'm pretty sure that the reason has not gone away. And we know what fluoride is being used for. And you're going to apply the fluoride and you're going to take care of the patient. And whether it's covered or not covered is something that is outside of your realm. Now, when I say outside of your realm, here is where the issue is. We have autonomy, or I would, at least in the practices that we've been a part of, like we have the autonomy to help the hygienist. Hey, you can give this at no cost, but you have to explain and educate the patient as to why it's important. Because you're not going to just keep giving it to them at no cost, right? So what is the ROI in regards to giving it at no cost? It's the education aspect. You know, they, the hygienist or the doctor thought this was so important that they didn't care about the insurance paying for it or not. And, you know, and they're going to have me do this. I mean, we we've taken this to the extent of even adult sealants. You know, nowadays we're looking at SDF, which essentially is like a higher grade, or to kind of keep it simple, it's a higher step than just the fluoride uh varnish. You know, and so like we'll separate that and just keep those two things separately. And then it also helps like arrest anything that any any cavities that might be starting, it will change it to a different color. So next time that they come in and it's arrested it or it's helped it and it's actually changed color. When you take a photo of that, look, you thought that this was just not happening, or it was on the fence. Well, this chemical interaction has turned that bacteria or killed it, and and now it's in the mouth and and and you can actually see it. So, like, yeah, we didn't charge you for, you know, we didn't charge you for it. Now it's arrested. Now you should probably put fluoride on it or, you know, see what the doctor says, see how extensive it is, and maybe you actually need to feel that now. You know, like it's a it's a pathway and finding a pathway to be able to get to the patient to be healthy. I think I I think it doesn't have to be like, don't sit there and look at the insurance. I think people unfortunately, you know, and I'm and I'm sure you can speak to this a lot more than me. How many people do you know that are like, how many dentists do you know, Erica? I wanna get, I wanna drop insurances. Insurance reimbursements are so low, right? So why are we why are we hindering or limiting ourselves by just looking at what's on the route slip?

SPEAKER_01:

Yeah, yeah, no, I agree with that. It's uh I think a lot of a lot of this when you know, I'll live workshops. Um you know, we we talk about code 4346 a lot. And what I get from the audience, and you know, I've spoken to the ADA's coding committee, I've called in and spoken to people there just to make sure that some of these things that are being talked about in my workshops, and I'll share that in a second, are still ethical. So, and ultimately when we choose to not submit a code for what we actually did, you know, that that's not the best practice, but offices are being forced to consider these types of things. And what I'm talking about is 4346, we know we just did a gingivitis cleaning on the patient. However, uh, we're gonna go ahead and submit for a pro fee because, you know, let's say Delta Dental reimburses less for 4346 than they do for a Pro FI. So the office knows that they didn't do a Pro FI. They know they did a gingivitis cleaning, but because the reimbursement is so low, they're they're like, there's no way I'm gonna get paid$40 for a gingivitis cleaning when I can get paid$68 for a Pro Fee. So they end up submitting. So that's one thing, that's one conversation around 4346. The other one is what if my patient ends up with a co-pay? So now I'm gonna take my patient from the free cleaning into, you know, now you need to pay a co-payment. It's just like any other treatment. I don't know how you feel about that, Ed, but like just like a, you know, yeah, that sometimes the insurance companies downgrade payments for different procedures and 4346, yep. Sometimes it does get downgraded to a profit. Sometimes it's covered at 80%, but not downgraded, but the patient ends up with a small copay, you know. But it's not, I think we get too caught up in what insurance is going to cover it. We're trying to fight for the patient's benefits, but at the same time, I really do want to encourage offices to document for what you do, code for what you do, and charge the patient accordingly. I think that, you know, earlier you said consistency builds trust. And I also believe that transparency builds trust too, you know, transparency around how the insurance is performing with the procedures that are being recommended and not always trying to people please our way through that conversation because you know, everyone's so afraid to present copayments because we allow the patient to believe that they have insurance. They don't have insurance. Dental insurance is a joke. In fact, in fact, I'm having fortune billing solutions coffee mugs made as we speak.

SPEAKER_00:

Uh-huh.

SPEAKER_01:

The other side of it, it says dental insurance is a joke.

SPEAKER_00:

It's a joke. That's fine.

SPEAKER_01:

I'm also having some canvas bags made to be giveaways at the event. And it says our has our logo, fortune billing solutions, but it also says dental insurance is a joke. And I, because I say that so many times a day, I I'm just like dental insurance is a joke. It's not insurance. So, you know, it I could that's a whole other episode. We're not even gonna go there.

SPEAKER_00:

Yeah.

SPEAKER_01:

You know, what are your thoughts around that?

SPEAKER_00:

Yeah. No, I mean, it's a you know, it's it's insane. Yeah, I mean, it's insane that$1,500 has been uh put in these uh piggy banks, if you want to call them, ever since what, 1980 or 60, exactly.

SPEAKER_01:

They used to just pay claims and now, but then they realize, hey, if we put a cap on it, because what they realize is people most of the general population don't they don't even use their benefits. Yeah. That's the real reason why annual maximums have not gone up. Insurance companies are winning because the general population doesn't use they don't use their benefits because half of America's afraid of the dentist. Yeah. So but they're paying, but they're paying for their benefits, they're paying their premiums. Insurance companies are winning on so many levels. You know, they're not always the bad guy. I know, you know, uh, most of the time I'm talking about how they bully the office. Sometimes you give them reasons to bully you, uh you know, by not appealing denials. But, you know, this is also one of those areas where the insurance company is winning because we're not putting 4346 on claims as often as we should, which makes it a utilization issue too. You want them to pay more for 4346, put it on the claim form when you do it, right? So make it a utilization. So let the insurance company see that we're actually utilizing and doing this procedure, and then we can go to bat and ask for more reimbursement around that. It's it's just a cat and mouse chase all the time.

SPEAKER_00:

Yeah, well, and like 4346 protocol, right? If there's any sort of adjunct stuff that's associated with that, such as the saliva testing or or period protect, those are gonna be a couple of things to get the patient healthy. But the mechanical cleaning is what's gonna resonate with the patient too. Like, hey, I got to come in more often because I got to do some more stuff. I gotta make sure things are like healthy inside the mouth. So they're gonna they're gonna do that. Once they actually come in more often or we're seeing them more, this is gonna help build trust as well. And and unfortunately, the reality is nine out of 10 patients, habits don't change. And when habits don't change, things become worse a little bit more worse. Well, guess what? Now at this next cleaning, or maybe the one after, they end up unfortunately being a candidate for a uh scaling and root root planning, and it's gonna be a limited one, you know. And and I think I think that's probably, and you can tell you you probably know about more about this than me. Like, that's probably a code that's really not being utilized either. You know, it's either all or nothing.

SPEAKER_01:

So yeah, we we did so a couple of years ago, we were really big on doing this in-depth analysis. I'll show it to you one day, but it's like we would we would analyze the top 10 codes that are utilized across the board in general dentistry, and and we would, so it was like D0120, so recall, pro fee, yeah, yeah, limited SRP, SRP paralemaintenance, and gendivitis cleanings. So we would go, okay, over the past 18 months, we do an 18-month look back, and 4346 was virtually non-existent, or 4342 was almost non-existent. Non-existent, right? Very, very seldomly used. But when you talk about the criteria, and by that, I don't mean me, I know the clinical criteria. I know I'm just the biller. That's why it's that's why the name of my book is called I'm Just the Biller. I know I'm just the biller, but as billers, and I think I'm speaking on behalf of all billers, we can read x-rays just as well. Of course. We we can read that period chart, we can look at intra-oral photos, like because we have to be trained to look at these things, not from a clinical standpoint, to diagnose, but to make sure that we can get paid. Of course. So we have to be able to do that. So even though I'm just the biller, I know that there is a very large population in the dental community, the very large portion that are still underutilizing the codes for services that they are doing. So when I explain to let's say a doctor, and I'm talking to the doctor about, you know, the clinical documentation that we look at, and I'm going, this was probably more likely a gintivitis cleaning. Um, I'm looking at the period chart, I'm looking at the the intraoral photos, I'm looking at everything, and I'm looking at the fee schedule, and I'm like, yeah, we got paid$68 because you documented a profi. We had to bill a profi, but if we were to look at it from and and really identify the type of cleaning that the patient had, this was more likely a jujivitis cleaning, and that would have paid you$108. You know, so it just is it's kind of for me, it's a little bit of everything, but I feel I definitely feel like there's underutilization of these codes. And I see it in virtually every billing consultation, see it, hear it in virtually every billing consultation. And I have billing conversations all day long that turn into clinical conversations. You know, I'm definitely not qualified by a license to have that conversation, but I know enough to know some stuff, you know, like so. Yeah, like I I really wanted your perspective on all this because we talk about it all the time. We see stuff, we see a lot of stuff.

SPEAKER_00:

Yeah, and I mean, like what we were saying earlier this morning, like people, people looking at when we the whole crown and buildup thing, you know, like I was telling you about the office that I was helping out a couple like a couple of days ago. I mean, they're they're sitting here, they don't want to bill codes because they were they went to some seminar or they went to some z, you know, online whatever thing that that they they watched where somebody told them that you can only bill a cleaning or a SRP only on that day. You cannot bill anything else, and so they don't want to you use any other codes unless I unless we turn the SRPs into three appointments essentially. Um, but they don't even want to do that, and then as I'm like deep diving into how they're doing stuff, well, when we bill a crown, the buildup is billed on one day and the crown is built on another, at least in that office, that's what they're doing. So I asked the office manager, who's by the way, not a big fan of me, but that's fine, you know. So we're sitting here, we're conversating. I'm like, okay, so tell me why this is different and why like that's okay and why this is not okay. And uh, yeah, she did not have a response, and she actually didn't, I didn't finish this conversation with you, but she actually like had a breakdown, not a breakdown, but she felt sick and she went home and after and then this this morning after you and I hung up. I actually literally right after we hung up, I got a phone call from the uh doctor, and and he's like, Hey, like, so what do you recommend that we do? And I said, What I recommend that we do is whatever that you're comfortable with. I'm not telling you to do something or not do something. I also want you to know what is ethical and not and not ethical, so we can go down this route and just be consistent. Again, it's back to being consistent of what you want to do. She's sitting over here telling me that I'm a money grabber and I'm I'm you know unethical, blah, blah, blah. You're literally doing this other stuff.

SPEAKER_01:

So, you know, like she's basically just following what insurance stipulates 100% that and and not going outside of the not going outside of those lines. So, yeah, this is this is classic. I mean, I see this a lot with office managers, billers that you know, I still get, I mean, on my TikTok, some people try and, you know, correct me with regards to I just did a post recently and I said, you know, you some people still believe you have to put everything you do on a claim form, and I was attacked. It was like, oh, yeah, you're in network, you have to. And you know, and I'm sitting here thinking, doesn't anybody know about the high tech act of 2009? Like it things have changed and shifted over the years, but there's still a lot of misinformation that gets tossed around, especially in these Facebook groups, or you've got somebody that's got three years of experience, is trying to be an up and up and come up and coming new rising influencer. So they're answering every question, giving a lot of bad information, but because everybody sees this person on a regular basis, they think this person's got to know something. And it's just frustrating to see that. But oh my god, there's so many people like that, Ed, that just go based on what insurance covers, and that's too bad. That is too bad.

SPEAKER_00:

I mean, yeah, it it's it's crazy. I recently decided to be part of a couple of like hajging groups and a couple of office manager groups, and I will take not people's information, but ask the same question in both groups. Oh, really? Yeah, so I recently did one that I asked in the manager groups as office manager, what are the things that you wished your hygienist knew? And then I took that same question and did it on the hygiene side. And you know, there's one of them has 300 comments and the other one has 450 comments. There's obviously a lot of stuff that's you know, attacking and whatever BS in there. But there is some there is some really good things in there. I mean, I would say, like, you know, most most hygienists don't realize there's a you know, there's a beginning of like that morning huddle that most offices should have, right? Yeah, the the morning huddle that most offices should have and the pre what are we calling it? The like prepping charts, right? Like both, yeah, both of those things should be happening. So the prep the chart prepping, I mean it's happening while while they're at work, it's not happening when they're at home, right? So that's something that they need to understand that the high that the office managers or the front office team is doing during those huddles. That information that's being said in those huddles, somebody had to put it together. Oh, yeah, you know, like yeah, and so it's things like that from that side, and then from the other side, I mean, a lot of office managers actually a lot of office managers in in the group said they would love if their hygienist did not talk about money. Yeah, yeah, because they're just self-limiting themselves. The end of the day, if you want to be treated as a clinician or as a provider, you tell the patient what they need and you allow your billing or your front office team to tell the patient their insurance stuff.

SPEAKER_01:

Yes, I I have a very specific process that I followed in my most recent partnership. The last practice I was a partner in was in Carson, California. We're in between a very tough demographic. If you're from California, you know Long Beach and Compton, and we were right smack in the middle. So it wasn't the highest income area. We were a dentical office, but I can tell you that our hygienist, he killed it with shout out to Alex. He killed it with with Arioprotect, he killed it with, we weren't doing oral DNA, but we did a lot of we did a lot of laser, a lot of laser. But one of the things that we had an agreement on is that he never talked about financials because he knew that we were gonna handle the financials in the front, right? Like so we knew every patient that came in for perio maintenance, we knew that Alex was gonna talk to them about laser bacterial reduction. We knew every patient that needed SRPs, Alex is going to recommend LAPT, right? Laser assisted periotherapy. You know, so we knew we kind of had a rhythm going so we would collect before the patient went to the back. Sure enough, Alex is recommending, you know, LBR, LAP, he's recommending all the things, period protect. And we just kind of knew that. But we he allowed us to do our job. We let him do his. He was great at educating the patients, you know, and so we just kind of had that rhythm going with the hygienist, but we had a very specific protocol and we stuck to our process. You know, front office talks about the money, back office, but you guys are the educators. Yeah, you know, and it worked out really well. We had very high case acceptance, even in a dentical practice. So to the rest of the country, that is called Medicaid. California is special, and we call it dentical.

unknown:

Yeah.

SPEAKER_01:

So, you know, but that's that was how we had it set up between hygiene and the front. And I think if more offices had that cohesiveness among the clinical and and front, you know, that would solve a lot of these financial conversations that are not being that are not happening.

SPEAKER_00:

Oh yeah, nine, 99.9% of all these of all these issues. Because I mean it's not like, you know, put yourself in the provider's chair or in the pro as a put yourself in the provider's shoes, because you are a provider. So just keep to what you know and don't guess the other stuff. I mean, if anything, if people are like overzealous and really want to be go-getters and want to actually talk about stuff, well, you can always talk about a ballpark. And you know, I tell people learn learn your learn your office's UCR fees. And so this is this is a little bit different, but yeah, you know, learn your office's UCR fees. And so if they you say a high number and they are told something completely less than that, guess what? You have won and you have don't look like a fool. Now the opposite happens, you know, that's a problem, right?

SPEAKER_01:

Yeah, they're quoting something too low, and the office office manager, treatment coordinator comes in and says it's double that price. Yeah, you definitely look like the money grabber there. So there's one last thing I want to talk about. Yes. And this is going more into leadership. And earlier when we were talking on the phone, I've heard you say this before. You encourage hygienists to treat their column like a business.

SPEAKER_00:

Yes.

SPEAKER_01:

So talk to us a little bit about that. Like, what do you mean by that? And I know a lot of hygienists are, you know, they're they're not business savvy. So when you say that, I'm sure that's kind of like what what do you mean, treat my column like a business?

SPEAKER_00:

So, you know, we won't use numbers, but we'll use multiple multiplications, and I'll keep it as as simple as possible. So everybody wants to get paid top dollar in order for you to get paid top dollar, there is a metric that requires your daily pay to be worth it for the practice, so their overhead is not a negative. So if we want to make a dollar per day for the whole day, that would be what our daily, you know, what our like what we're getting paid per hour or whatever. So you need to make 3.5x of that in your column. So if so if you're making, I guess maybe I I made it more complicated by not adding numbers. So, you know, so like uh let's say you're making$50 an hour and you work eight eight hours a day. So so what is that for 50 times eight? 400, right? So if you're making 400 a day, then you want to be doing 3.5x of that. So you take the 400 times it by 3.5. Sorry guys, I I live by my calculator here.

SPEAKER_01:

400 times 3.5. 1400.

SPEAKER_00:

Yeah, so that's what we're looking at. This is what you need to be making every day in order for you to be able to pay yourself from that column. Now, pay yourself from that column. This is a sentence that I'm saying, and I want it to be underlined. Think of that being underlined a bunch of times. Why? So the that amount of money is your basically bare minimum for yourself to not put yourself in the negative. Now you go above that, below that, your scheduling needs to be in that however that is set up, and each office is a little bit different. Some fee-for-service offices, if you have one SRP, that's already a thousand bucks. Right. There's some offices that don't have that, or don't have other services, or take off the x-rays. You know, there's there's a lot of variations, but that's how you set your column to be as such.

SPEAKER_01:

3.5 times your daily rate.

SPEAKER_00:

Yes, your daily rate.

unknown:

Okay.

SPEAKER_00:

That's really that's essentially how it is. Now you have to be you have to have ownership and be accountable for your column because sometimes, you know what, you know, we're all busy or something comes up, you might have to leave early, and then now you've moved these patients to another day. Well, you can't cram yourself in one day in a different day, and then have nothing the following day. It's all about balance. So if you help your front office and your office manager have what is an ideal schedule for you, not just to be doing profis, but to have, you know, a couple of maybe one SRP, a couple of prayer maintenances, a couple of re-evaluations. I mean, I've we've kind of gone as far as let's cater to what we need, but make it intentional.

SPEAKER_01:

Right, right. Yeah, I think that that's really important because treating your column like a business really does help open the eyes to how the you know, whether or not the office can support that, I don't know,$75 an hour rate in California for hygienics.

SPEAKER_00:

Well, yeah, and and then you know, so that's just the baseline, right? So now three months into this, we want to raise, or three months into this, this is the other thing that I'm running into. We want new instruments. Okay, well, have we been able to have a little bit higher of a cushion? In that is there money left over for these things to happen? I mean, you that's how you think that it's a business. Like a business doesn't just run at no profit, right? You need a little bit of profit in order for that stuff to carry over. And you know, I'm not telling you go do a five or six thousand dollar column, but I'm telling you that you have to be consistent in what you're doing. It's like working out. If you can lift 10 pounds, then you know we're gonna help you to be able to lift 12 pounds and 15 pounds, and you slowly grow within your eight hours or your eight patients. And you know, there's a lot of things out there that we're able to do. You just also have to invest in yourself in order for you to be able to do those things and ultimately practice at the highest level of your license.

SPEAKER_01:

I like that. So I interviewed another hygienist years ago. Her name's Elaine Rodriguez, and she's a laser, uh she trains on integrating lasers back then.

SPEAKER_00:

Uh she's she still does it, she she does uh courses for them now.

SPEAKER_01:

Oh, great, awesome. Laser integrations is the name of her company. And we actually had her out to my practice in Carson, and we saw a 300% increase. She trained Alex, our hygienist, on how to do the laser. She trained our assistants because in California the assistants at that time were able to do LBR. So all of our assistants were doing the LBR, and Alex was trained to do that. We saw 300% increase. Increase in hygiene production after she came out to the practice. It was just amazing. However, what she said was right along the lines of what you're saying. She always says you need to treat your hygiene department like it's its own business. So she said, you know, hygiene is a business within a business and it has its own KPIs and own your its own metrics. And I love how you kind of take that a step further and you say, treat your column like a business. Because yeah, I mean, at the end of the day, when we sit down to calculate hygiene bonuses and we're talking about, you know, did the hygiene did did we meet bam fair and minimum? You know, did we go above bam for the day? You know, like are we gonna do a daily bonus system? And that that Ed, I will not tap into right now because we've already been talking for about an hour. And um, I'm pretty sure this is gonna be a part one and a part two. So I told you this was gonna happen. I've before I press record, I was like, okay, I'm gonna put a timer, I'm gonna set an alarm because you and I can sit here and talk for hours, and it will end up with like three-part series. So it's already a two-part series. But yeah, so like the the bonus structure, maybe that'll be a whole other conversation.

SPEAKER_00:

Oh, yeah, yeah, yeah, yeah.

SPEAKER_01:

That bonus structure bewilders so many doctors, they just don't know what to do, how to what how should I structure my bonus system? So we'll leave that for another conversation for sure. Before we close out, is there any last words that you want to give me fellow hygienists?

SPEAKER_00:

Oh, I mean, I would say I would say don't don't take things personal. You know, it's a stressful field, really be open-minded and and we don't know everything. And I think the end of the day, we're all here for the same thing. We all want to help patients and we want to make sure that we get home to our family safe. I I think like a lot of people just take things too personal and and don't understand that you know there's no I in team, and so everybody just has their own part and they should all work together.

SPEAKER_01:

So yeah, I agree with that 100%. Well, if if anybody wants to get a hold of you, Ed, did you do you want to give them a little bit more?

SPEAKER_00:

Yeah, we can use yeah, yeah, we can use the Fortune 500 email fortune billing or fortune billing email.

SPEAKER_01:

And you can find Ed if you want to reach out to him and connect with Ed, you can reach out. I'll put a link to his email in the show notes as well. But it's Ed at dentalbillingdonewright.com. And Ed, thank you so much for being on the podcast. It's been a pleasure, and I'm sure we'll continue this conversation once I stop recording.

Head Shot

Ericka Aguilar

Host