Help to Correct my CMS 1500 form for Dental work billed to medical insurance under accidental dental coverage with BCBS

I fell down the stairs and broke my teeth. BCBS of Minnesota has an accidental dental coverage and I need to fill out the CMS 1500 form. The dentist doesn't do medical billing. I spent 5 hours and submitted the form to get back that I made an error "the charges are missing or invalid. The total charges provided minus the adjustments do not equal the amount due" The reason I need help is the office broke down each charge and code to do what they call "Teeth in a day" you can google it. They do extractions, bone grafts, implants and insert dentures the same day and charge 1 Price $46666.40. But their receipt breaks down each procedure by tooth so tooth #2 has 5 codes each with a normal charge for example D4264- bone graft-fee $885.00-Patient cost $177.00-prin insurance $708.00 and there are 4 more just for tooth #2. And this is listed that way for 27 teeth. Since you're doing the teeth in a day called AOX its one price and you get a discount of $46666.40 instead of $71465.60 if you were charged individually. I don't know how to correct my form 1500 to show that because I listed them separate which is why I got the error of invalid prices that don't add up. Can you help me please look over and correct my cms-1500 form. I have attached below what I received today from insurance as this is my 2nd try for reimbursement and the office won't help neither will BCBS.