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.