Top 5 Open Dental Challenges in Practices

(and How We Actually Fix Them)

I’ll be honest, when I was first asked to speak about Open Dental, I laughed. I’m not a polished public speaker, and the thought of standing in front of a room full of dental professionals with PowerPoint slides made me… mildly queasy.

But here’s the thing, what I’ve learned after analyzing over 100 Open Dental databases has completely changed how I think about dental software, and how teams can make it work for them instead of fighting against it. So I couldn’t not share.

If you’ve ever felt like your Open Dental is a little messy (or maybe a full-on dumpster fire), you’re not alone. And the good news? Most of the chaos comes from a few small things that can be fixed, fast.

So here are the top 5 challenges I see in Open Dental… and the fixes that make Monday mornings way easier.

1. Insurance Plan Duplicates: The Hidden Chaos

I can’t even count how many databases I’ve opened where insurance plans are multiplied like Gremlins after midnight.

I once walked into an office where the team was calculating treatment plans with pens, paper, and calculators while patients sat waiting to go home. Why? Because their insurance setup was such a mess that nothing calculated correctly.

The fix? Start using the Pick From List button and search by group number before creating a new plan. That one simple step can save you hours of cleanup and verification time.

And if you’re updating benefits, make sure you’ve got the toggle right, “change plan for all subscribers” vs. “create new plan if needed” can be the difference between clean data and more duplicates.

2. Procedures Not Billed: The $63,000 Surprise

One of my favorite (and least favorite) client stories: I ran a “Procedures Not Billed” report for a doctor who thought his numbers looked off. We found $63,000 (!) in completed procedures that were never billed.

I wish I could say that’s rare, it’s not.

Every team should be running this report daily before batching claims, and at least once a year going back to catch anything within timely filing. If something shouldn’t be billed, mark it as “Do Not Bill.” If it should, create the claim.

Otherwise, your reports lie to you. And that never ends well.

3. Definitions: Because No Two Databases Are the Same

If you’ve ever wondered why your Open Dental doesn’t look or function like someone else’s, it’s probably because of Definitions.

This is where the customization lives. It’s powerful, but it’s also where things go off the rails.

Keep your Adjustment Types, Billing Types, and Payment Types simple and intentional. You don’t need a 5%, 10%, and “Cash Discount” adjustment unless you’re actually tracking them separately. More isn’t better here, more just makes your reports confusing and your team inconsistent.

4. Refunds: The Sneaky Accounting Trap

A dentist once called us convinced someone was stealing. His income reports were high, but the money wasn’t in the bank.

Turns out, his team had been entering refunds as adjustments instead of negative payments, for five years.

If you’ve ever worked in another software, that might feel normal, but in Open Dental, adjustments reduce production, which makes it look like you produced less and collected more.

The fix? Post refunds as negative payments (not adjustments).

Never alter historical data, use counter-adjustments and income transfers to fix past mistakes. Trust me, no one wants to open a time-travel loop in Open Dental.

5. Appointment Views: The Unsung Hero

One of my favorite “aha!” moments came from an office where a front desk team member was spending 3–4 hours every day manually checking which patients needed insurance verification, recall, or had a balance.

They were drowning in busywork, until we showed them Appointment Views.

These customizable filters let you see exactly what you need at a glance, balances, recalls, unsent claims, without digging through patient charts. It’s the ultimate sanity-saver.

My Challenge to You

If you’ve made it this far, here’s my challenge: pick one of these fixes and implement it Monday morning.

Don’t overhaul your entire system. Just start with one. Whether it’s cleaning up your carrier list or running that Procedures Not Billed report, every small change moves you closer to a database that actually supports your team.

Because here’s the truth, Open Dental isn’t the problem. The setup is.

And once you know how to make it work for you… your workday gets a whole lot lighter.