HealthChoice Removes Certification Requirements and Modifies Category Assignments for Many Dental Procedures
Posted 08/16/12
Effective for charges incurred on or after January 1, 2013, the following dental procedures will continue to require certification:
|
ADA Code |
Code Description |
Category |
|
D8040 |
Limited orthodontic treatment of the adult dentition |
DD |
|
D8090 |
Comprehensive orthodontic treatment of the adult dentition |
DD |
|
D8210 |
Removable appliance therapy |
DD |
|
D8220 |
Fixed appliance therapy |
DD |
|
D8660 |
Pre-orthodontic treatment visit |
DD |
|
D8670 |
Periodic orthodontic treatment visit (as part of contract) |
DD |
|
D8680 |
Orthodontic retention (removal of appliances, construction and placement of retainer (s)) |
DD |
|
D8690 |
Orthodontic treatment, (alternative billing to a contract fee) |
DD |
|
D8691 |
Repair of orthodontic appliance |
DD |
|
D8692 |
Replacement of lost or broken retainer |
DD |
|
D8693 |
Re-bonding or re-cementing, and/or repair, as required, of fixed retainers |
DD |
|
D8999 |
Unspecified orthodontic procedure, by report |
DD |
All procedures require certification for members and covered dependents older than age 19 with a diagnosis of Temporomandibular Joint Dysfunction.
Effective for charges incurred on or after January 1, 2013, the current categories assigned to the following dental procedures will change. The changes are as follows:
|
ADA Code |
Code Description |
Category |
|
D0160 |
Detailed and extensive oral evaluation, problem focused, by report |
AA |
|
D0340 |
Cephalometric film |
AA |
|
D0350 |
Oral facial images (includes intra and extraoral images) |
AA |
|
D0472 |
Accession of tissue, gross examination, preparation and transmission of written report |
AA |
|
D0473 |
Accession of tissue, gross and microscopic examination, preparation and transmission of written report |
AA |
|
D0474 |
Accession of tissue, gross and microscopic examination, including assessment of surgical margins for presence of disease, preparation and transmission of written report |
AA |
|
D0480 |
Processing and interpretation of exfoliative cytologic smears, including the preparation and transmission of written report |
AA |
|
D0486 |
Laboratory accession of brush biopsy sample, microscopic examination, preparation and transmission of written report |
AA |
|
D0502 |
Other oral pathology procedures, by report |
AA |
|
D0999 |
Unspecified diagnostic procedure, by report |
AA |
|
D2931 |
Prefabricated stainless steel crown – permanent tooth |
CC |
|
D2932 |
Prefabricated resin crown |
CC |
|
D2933 |
Prefabricated stainless steel crown with resin window |
CC |
|
D2952 |
Cast post and core in addition to crown |
CC |
|
D2953 |
Each additional cast post – same tooth |
CC |
|
D2954 |
Prefabricated post and core in addition to crown |
CC |
|
D2955 |
Post removal (not in conjunction with endodontic therapy) |
CC |
|
D2957 |
Each additional prefabricated post – same tooth |
CC |
|
D2960 |
Labial veneer (resin laminate) – chairside |
CC |
|
D2961 |
Labial veneer (resin laminate) laboratory |
CC |
|
D2962 |
Labial veneer (porcelain laminate) - laboratory |
CC |
|
D2971 |
Additional procedures to construct new crown under existing partial denture framework |
CC |
|
D2975 |
Coping |
CC |
|
D2999 |
Unspecified restorative procedure, by report |
BB |
|
D4210 |
Gingivectomy or gingivoplasty – four or more contiguous teeth or tooth bounded spaces per quadrant |
BB |
|
D4211 |
Gingivectomy or gingivoplasty – one to three contiguous teeth or tooth bounded spaces per quadrant |
BB |
|
D4230 |
Anatomical crown exposure – four or more contiguous teeth per quadrant |
BB |
|
D4231 |
Anatomical crown exposure – one to three contiguous teeth per quadrant |
BB |
|
D4240 |
Gingival flap procedure, including root planning – four or more contiguous teeth or tooth bounded spaces per quadrant |
BB |
|
D4241 |
Gingival flap procedure, including root planning – one to three contiguous teeth or tooth bounded spaces per quadrant |
BB |
|
D4245 |
Apically positioned flap |
BB |
|
D4249 |
Clinical crown lengthening – hard issue |
BB |
|
D4260 |
Osseous surgery (including flap entry and closure) – four or more contiguous teeth or tooth bounded spaces per quadrant |
BB |
|
D4261 |
Osseous surgery (including flap entry and closure) – one to three contiguous teeth or tooth bounded spaces per quadrant |
BB |
|
D4263 |
Bone replacement graft – first site in quadrant |
|
|
D4264 |
Bone replacement graft – each additional site in quadrant |
BB |
|
D2465 |
Biologic materials to aid in soft and osseous tissue regeneration |
BB |
|
D4266 |
Guided tissue regeneration –resorbable barrier, per site |
BB |
|
D4267 |
Guided tissue regeneration – nonresorbable barrier, per site, (includes membrane removal) |
BB |
|
D4268 |
Surgical revision procedure, per tooth |
BB |
|
D4270 |
Pedicle soft tissue graft procedure |
BB |
|
D4271 |
Free soft tissue graft procedure (including donor site surgery) |
BB |
|
D4273 |
Subepithelial connective tissue graft procedure, per tooth |
BB |
|
D4274 |
Distal or proximal wedge procedure 9when not performed in conjunction with surgical procedures in the same anatomical area) |
BB |
|
D4275 |
Soft Tissue allograft |
BB |
|
D4276 |
Combined connective tissue and double pedicle graft, per tooth |
BB |
|
D4999 |
Unspecified periodontal procedure, by report |
BB |
|
D5650 |
Add tooth to existing partial denture |
CC |
|
D5660 |
Add clasp to existing partial denture |
CC |
|
D5670 |
Replace All teeth and acrylic on cast metal framework (maxillary) |
CC |
|
D5671 |
Replace All teeth and acrylic on cast metal framework (mandibular)) |
CC |
|
D5810 |
Interim complete denture (maxillary) |
CC |
|
D5811 |
Interim complete denture (mandibular) |
CC |
|
D5820 |
Interim partial denture (maxillary) |
CC |
|
D5821 |
Interim partial denture (mandibular) |
CC |
|
D5850 |
Tissue conditioning, maxillary |
CC |
|
D5851 |
Tissue conditioning (mandibular) |
CC |
|
D5867 |
Replacement of replaceable part of semi-precision or precision attachment (male or female |
CC |
|
D5875 |
Modification of removable prosthesis following implant surgery |
CC |
|
D6920 |
Connector bar |
CC |
|
D6940 |
Stress breaker |
CC |
|
D6950 |
Precision attachment |
CC |
|
D6970 |
Cast post and core in addition to fixed partial denture retainer |
CC |
|
D6972 |
Prefabricated post and core in addition to fixed partial denture retainer |
|
|
D6975 |
Coping - metal |
CC |
|
D6976 |
Each additional cast post – same tooth |
CC |
|
D6977 |
Each additional prefabricated post – same tooth |
CC |
|
D6985 |
Pediatric partial denture, fixed |
CC |
|
D7291 |
Transseptal fiberotomy/supra crestal fiberotomy, by report |
BB |
|
D7465 |
Destruction of lesion by physical or chemical method, by report |
BB |
|
D7899 |
Unspecified TMD procedure, by report |
BB |
|
D7981 |
Excision of salivary gland, by report |
BB |
|
D7995 |
Synthetic graft – mandible or facial bones, by report |
BB |
|
D7996 |
Implant – mandible for augmentation purposes (excluding alveolar ridge), by report |
BB |
|
D7999 |
Unspecified oral surgery procedure, by report |
BB |
|
D9310 |
Consultation (diagnostic service provided by a dentist or physician other than practitioner providing treatment) |
BB |
|
D9410 |
House/extended care facility call |
BB |
|
D9420 |
Hospital call |
BB |
|
D9430 |
Office visit for observation (during regularly scheduled hors) – no other services performed |
BB |
|
D9440 |
Office visit –after regularly scheduled hours |
BB |
|
D9450 |
Case presentation, detailed and extensive treatment planning |
BB |
|
D9610 |
Therapeutic drug injection, by report |
BB |
|
D9612 |
Therapeutic parenteral drugs, two or more administrations, different medications |
BB |
|
D9630 |
Other drugs and/or medicaments, by report |
BB |
|
D9920 |
Behavior management, by report |
BB |
|
D9930 |
Treatment of complications (post-surgical) unusual circumstances, by report |
BB |
If you have questions about dental certification requirements or the classification changes, contact Network Management at 1-405-717-8790 or toll-free 1-800-543-6044. Please submit email inquiries to oseegibproviderrelations@sib.ok.gov.
Last Modified on 08/16/2012