Free dental template

Free Dental Invoice Template

Invoice your dental patients with pre-loaded CDT codes for exams, cleanings, X-rays, and fluoride. Edit anything, preview, then save as PDF — all in your browser.

Invoice status

Ready to export or send.

100%

Invoice details

Invoice numberIssue dateDue date

From (you)

Business nameEmailAddress

To (client)

Client nameEmailAddress

Line items

DescriptionQtyRate ($)

Tax & notes

Tax rate (%)Payment terms

Notes

Your Business Name [email protected] 123 Main St, Suite 100, New York, NY 10001

INVOICE

INV-001

Bill to

Client Name [email protected] 456 Park Ave, Floor 3, New York, NY 10022

Issue date

2026-07-29

Due date

2026-08-28

Payment terms

Net 30

Description	Qty	Rate	Amount
Comprehensive exam (D0120)	1	$95.00	$95.00
Prophylaxis — Adult (D1110)	1	$120.00	$120.00
Bitewing X-rays (D0274)	1	$75.00	$75.00
Fluoride treatment (D1208)	1	$45.00	$45.00

Subtotal$335.00

Total$335.00

Notes

Thank you for your business!

Export note

Use Print / Save PDF after the invoice is complete. The exported document hides editing controls automatically.

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Dental Business Benchmarks

Key metrics

Average rate: $75–$300/procedure; varies by insurance
Common services: cleanings & exams, fillings & crowns, orthodontics, cosmetic dentistry, oral surgery
Payment terms: Due at time of service; payment plans available for major procedures

Typical invoice line items

• procedure code (CDT)
• provider name
• insurance estimate
• patient responsibility
• lab fees

See full industry benchmarks →

How to use this template

1Add practice name, dentist name, NPI number, and contact info
2List each procedure with CDT code, tooth number, and fee
3Show insurance estimated coverage and patient responsibility
4Include lab fees, consultation fees, and imaging separately
5Note payment method and any financing plan details

Frequently asked questions

Is this dental invoice template free?+

Yes. No sign-up, no watermark, no limits. Built for dental practices, orthodontists, and oral surgeons.

What CDT codes are pre-loaded?+

The template includes D0120 (exam), D1110 (prophylaxis), D0274 (bitewing), and D1208 (fluoride). Edit with any CDT procedure code.

Can I show insurance and patient portions?+

Yes. Add separate line items for insurance estimated coverage and patient responsibility. Show the total patient balance due clearly.

Should I include my NPI number?+

Yes. Add your NPI and practice license number to the sender details. This is required for insurance claims processing.

How do I handle payment plans?+

Note the financing plan in the invoice terms. Include the down payment, monthly amount, number of payments, and interest rate if applicable.