Codes Added to the Secondary Claim Billing Process for Orthodontia

Effective January 1, 2026, orthodontic codes D8010, D8020, D8030 and D8040 will be added to the Secondary Claim Billing Process for Orthodontic services. 

Updated Orthodontia Secondary Billing Reminder

MaineCare reimburses a one-time, lump sum payment on orthodontic codes D8010, D8020, D8030, D8040, D8070, D8080, and D8090 while commercial insurance plans may pay more frequently throughout a patient’s course of treatment. This has resulted in multiple claims adjustments and difficulty matching primary carrier’s Explanation of Benefits (EOBs) to MaineCare claims for secondary payment determination.

To prevent claims for these services from denying, when there is a primary payer, please submit claims for these orthodontic codes as follows:

  • PA Request: Submit a copy of the primary dental insurance carrier’s predetermination letter with the PA request. The PA will be issued for all approved dental code(s) supplied on the predetermination letter for the difference between the MaineCare allowance and the primary insurance predetermination benefit amount.
  • Claim Submission: Please do not submit these claims on the Direct Data Entry (DDE) portal or with 837 transactions. Paper claims must be submitted to ensure accurate payment calculation. Include a copy of the EOB showing payment from the other carrier has begun OR a predetermination letter from the member’s primary dental insurance carrier indicating the Third Party Liability (TPL), but do not mark any TPL payment on the claim. The claims will pend for review and will be priced according to the amount authorized by MaineCare.
  • Billing Additional Codes: If you are billing for a dental code in addition to codes D8010, D8020, D8030, D8040, D8010, D8020, D8030, D8040, D8070, D8080, or D8090, submit the code on a separate claim with the TPL payment included. A claim with one of the listed orthodontic codes and an additional code will be rejected with a Returned to Provider Letter (RTP).

If the amount that the primary dental insurance carrier pays toward the orthodontia changes at any time during the member’s course of treatment, you must initiate updates to the PA and request an adjustment on any paid claim. Claims that do not follow these guidelines will be denied.

For questions, please contact Shannon Beggs, Provider Relations Specialist.