IMAGING MODALITIES SUPPORTED
Panoramic
Periapical
Intraoral photos
Intraoral scans
CBCT
Cephalometric
Where fraud concentrates
30–40%
Billing not rendered
Services claimed that were never performed. AI validates against radiograph evidence.
20–25%
Upcoding
Crown billed when a restoration was appropriate. AI matches clinical evidence to billed code.
10–15%
Unnecessary treatmen
Procedures not clinically justified. AI validates indication against imaging findings.
THE PROBLEM
Most dental claims still clear adjudication without image validation. Upcoding, phantom procedures, and unjustified treatment slip through at scale. The NHCAA puts dental fraud and abuse at $7–12.5B annually. Nexttide closes the gap — every CDT code matched against the clinical image before payment clears.
What Nexttide does
CDT code validation
Every claim matched against the clinical image. Radiograph + code coherence checked automatically.
Anomaly detection
Utilization patterns flagged against peer benchmarks. Ghost patients and frequency inflation surfaced before payment.
Faster adjudication
Automated review reduces manual workload and shortens adjudication cycles from weeks to hours.
Population risk pricing
Oral health profiles built from AI findings and claims — enabling risk-based pricing and DSO negotiation.
By the numbers
$7–12.5B
lost annually to dental fraud (NHCAA)
$2.4–7.4B
potential annual savings at scale
70–80%
of fraud addressed by AI image + code validation