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‘2025년 요양급여 청구 부당사례 모음집’에 수록된 치과 진료 사례 분석

A review of dental-related cases in the 2025 compilation of improper health insurance claims

Abstract

In dental practice, claims for National Health Insurance reimbursement are an essential extension of clinical care, and dentists ultimately bear responsibility for the accuracy of insurance claims. This study analyzed dental-related cases included in the 2025 Compilation of Improper Health Insurance Claims published by the Health Insurance Review and Assessment Service and the Ministry of Health and Welfare of Korea to examine patterns of claim errors frequently occurring in routine dental practice. The findings suggest that these errors reflect structural vul nerabilities within dental clinic workflows, and that strengthening basic internal review systems may contribute to the prevention of improper insurance claims.(J Korean Dent Assoc 2026; 64(2): 45-47)

keywords
Insurance, Health, Insurance Claim Review, Reimbursement Mechanisms

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