Multiple Surface Restorations, Same Tooth

Policy No: 67B
Originally Created: 01/01/1999
Section: Miscellaneous
Last Reviewed: 01/01/2019
Last Revised: 01/01/2018
Approved: 01/01/2018
Effective: 01/01/2018

Description

Multiple Surface Restorations, Same Tooth
A multiple surface restoration is one which restores more than one surface of a tooth.

Policy/criteria

Procedure is in accordance with generally accepted standards of dental practice.

Administrative guidelines

Process to contract benefits.

Surfaces that are contiguous should be processed as a single restoration. Restoration surfaces not contiguous should be processed as a separate restoration. Apply policy to molars and bicuspids and do not apply to anteriors.

Disclaimer

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