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Dental Invoice Template

Create professional dental invoices for exams, cleanings, x-rays, fillings, and procedures. This dental invoice template is ideal for dentists and clinics that need clear itemized patient billing and documentation for reimbursement. Download instantly in PDF, Word, or Excel format.

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Industry Standard

From

Branding & Authorization

Services

$90.00
$110.00
$85.00
$160.00
$0.00

Invoice Details

Tax, Discount & Shipping

Payment Methods

Bill to

Subtotal$445.00
Total (USD)$445.00

What to Include on a Dental Invoice

Dental invoices should provide a clear breakdown of services and help patients understand charges, especially when reimbursement is involved.

Clinic and provider details
  • Clinic name and contact info
  • Dentist/provider name
  • Practice address
  • License/registration (optional)
Patient/customer details
  • Patient name (or responsible party)
  • Billing contact information
Service details
  • Date(s) of service
  • Treatment summary (professional and minimal)
  • Optional note about treatment plan reference
Common dental line items
  • Exam/consultation
  • Cleaning (prophylaxis)
  • X-rays (bitewing/panoramic)
  • Fillings
  • Crowns/bridges
  • Root canal treatment
  • Whitening
  • Extractions
Totals and payment
  • Subtotal, tax (if applicable), total due
  • Payment status (paid vs due)
  • Optional insurance/claim reference

Common Dental Billing Items and Pricing Structure

Dental billing is typically based on procedure types. Itemizing helps patients understand what was performed.

Typical items
  • Exam/consultation
  • Cleaning
  • X-rays
  • Fillings by tooth and material type
  • Major procedures (crowns, root canals, extractions)
  • Cosmetic treatments (whitening)
Why itemization matters
  • Patients can verify treatment received
  • Insurance or reimbursement documentation is clearer
  • Clinic billing is easier to reconcile and explain
If you use standardized procedure codes internally, you can keep the invoice patient-friendly while still maintaining accurate records in your system.

Dental Invoices for Insurance and Reimbursement

Some patients use dental invoices as receipts or supporting documents for reimbursement. Requirements vary by insurer, but consistent invoice details help.

Helpful fields
  • Clinic/provider name and address
  • Date(s) of service
  • Itemized services and charges
  • Total paid and payment method (if it’s a receipt)
  • Claim/reference number (if used)
Best practice: Keep descriptions professional and avoid unnecessary clinical detail. Treatment charts and records belong in clinical documentation, not on an invoice.

Payment Policies Common in Dental Practices

Clear payment policies help avoid confusion and follow-up billing issues.

Common policies
  • Payment due at time of service
  • Patient responsible for balances not covered by insurance
  • Deposit required for major procedures (optional)
  • Cancellation/no-show policy (optional)
Include only policies you enforce and keep the wording consistent across invoices.

Frequently Asked Questions