Dental Policy

The purpose of our Dental Reimbursement 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 comment regarding a dental policy, please complete the Dental policy feedback form.

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

Dental policy renewals effective December 1, 2022:

Miscellaneous:

  • Temporomandibular Joint Dysfunction (#68)

    • Annual review
    • No changes

Oral and Maxillofacial Surgery:

  • Oral and Maxillofacial Surgery (#75)

    • Annual review
    • No changes

Periodontics:

  • Mucogingival Surgery and Soft Tissue Grafting (#76)

    • Annual review
    • No changes

Prosthodontics:

  • Surgical Placement of Implants (#39)

    • Annual review
    • No changes

Restorative:

  • Buildups (#18)

    • Annual review
    • No changes

Diagnostic

Endodontics

Oral and maxillofacial surgery

Periodontics

Prosthodontics

Restorative