Free Dental Invoice Template
A free, professional dental invoice template you can download as Word, Excel, PDF, or Google Docs and Sheets. Designed for dental practices to bill patients with CDT procedure codes, insurance estimates, and patient-responsibility balances after claims.
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| Description | Qty | Unit price | Amount |
|---|---|---|---|
| Comprehensive exam (D0150) | 1 | $95.00 | $95.00 |
| Dental cleaning — adult prophylaxis (D1110) | 1 | $110.00 | $110.00 |
| Bitewing X-rays — four films (D0274) | 1 | $65.00 | $65.00 |
| Composite filling — one surface (D2391) | 2 | $185.00 | $370.00 |
| Fluoride treatment (D1208) | 1 | $40.00 | $40.00 |
| Subtotal | $680.00 | ||
| Sales tax (8%) | $54.40 | ||
| Total | $734.40 | ||
Example figures — every field is editable in the download.
Who uses this template
- ✓General dental practices
- ✓Orthodontists and specialists
- ✓Dental hygienists billing patients
- ✓Pediatric dental offices
- ✓Dental billing administrators
What to include
- ✓Practice name, address, and Tax ID (EIN)
- ✓Provider name and NPI number
- ✓Patient name and date of service
- ✓CDT procedure codes and tooth numbers
- ✓Fee per procedure
- ✓Insurance estimate and amount billed to carrier
- ✓Patient responsibility (copay, deductible, balance due)
Available in 5 formats
Word (.docx)
Fully editable in Microsoft Word, Google Docs, Apple Pages and LibreOffice — best for quick text edits.
Excel (.xlsx)
Line totals, subtotal and tax calculate automatically — best if you want the math done for you.
A clean, print-ready, fixed layout — best for emailing a finished invoice to a client.
Google Docs / Sheets
Open in your browser, then File → Make a copy to edit and share with your team.
Invoicing tips for dental
- ✓ List the CDT code alongside each procedure so it matches the insurance claim
- ✓ Show the insurance estimate and the patient-responsibility balance separately
- ✓ Include the provider NPI and practice Tax ID for claim and HSA/FSA reconciliation
- ✓ Note tooth numbers for restorative work to avoid coding disputes
- ✓ Offer a clearly stated payment plan or financing option for larger treatment plans
Dental invoice FAQ
What are CDT codes on a dental invoice?
CDT (Current Dental Terminology) codes are standardized procedure codes maintained by the ADA. Listing the code next to each service keeps the invoice aligned with the insurance claim and patient records.
How do I show insurance versus patient responsibility?
List the full fee, the estimated insurance portion, and the remaining patient balance (copay, coinsurance, or deductible) on separate lines so patients understand what they owe out of pocket.
Can patients use HSA or FSA funds to pay?
Yes. Dental care is HSA/FSA-eligible. Include the practice Tax ID, provider name, procedure detail, and date of service so the receipt qualifies for reimbursement.
Is sales tax charged on dental services?
Dental and other healthcare services are generally exempt from sales tax. Some over-the-counter products sold by the office may be taxable, so itemize those separately.
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