Claims Review
Our consultants are on hand to quickly and thoroughly review paper claims and predeterminations.
Please submit the following documentation when submitting claims for the services listed:
| Onlays, Veneers & Crowns | Recent periapical X-ray that displays the tooth apex |
| Root Canal Retreatment | Pre-retreatment periapical radiograph, reason for retreatment and date of original root canal |
| Scaling/Root Planing, Osseous Surgery, Gingivectomy | Recent periodontal charting and full mouth series or panorex |
| Soft Tissue Grafting | Recent periodontal charting and narrative indicating amount of remaining attached gingival |
| Crown Lengthening | Recent pre-operative periapical X-ray |
| Implants | Recent pre-operative full mouth series or panorex |
| Fixed and Removable Prosthesis | Recent pre-operative full mouth series or panorex, if a replacement — age of previous prostheses and reason for replacement |
| Core Build Up and Post and Core | Pre-operative X-ray for core build up and post-root canal therapy X-ray for post and core |
In addition, please remember:
- To avoid delays in claim reimbursement, CDT codes D7230, D7240 and D7241 require the submission of a medical EOB.
- Always send readable X-rays. If the image is not clear to you, it will also be difficult for the reviewer to read.
- Never submit your original X-rays. Submit duplicates or use double film packets.
- If necessary, please include a narrative in support of the requested service.
- Indicate which teeth are missing in the arch in the "Missing Tooth" section of the claim form.
