Dental Policy

The purpose of our Dental Policy Manual is to document the sources and principles used in writing our Dental Policies. This information is to be used as a general reference resource regarding our Dental Policies and not intended to address every aspect of a dental situation. Reasonable discretion may be used in applying our Dental Policies to individual situations.

The following national source, the American Dental Association (ADA) Code on Dental Procedures and Nomenclature (CDT), is consulted in the development of our health plan Dental Policies.

Comments from dental providers regarding dental policies are welcome. If you have a question or comment regarding a dental policy, please contact your provider relations representative.

Your use of this Dental Policy constitutes your agreement to be bound by and comply with the terms and conditions of the Dental Policy Disclaimer.

What's new

Adjunctive general services

Diagnostic

Endodontics

Miscellaneous

Oral and maxillofacial surgery

Orthodontics

Periodontics

Preventive

Prosthodontics

Restorative