Repair of Orthodontic Appliance

Policy No: 54A
Originally Created: 01/01/2002
Section: Orthodontics
Last Reviewed: 01/01/2019
Last Revised: 01/01/2018
Approved: 01/01/2018
Effective: 01/01/2018

Description

Repair of orthodontic appliance (D8691)
Does not include bracket and standard fixed ortho appliances. It does include functional appliances and palatal expanders.

Policy/criteria

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

Administrative guidelines

Process to orthodontic benefit.

Codes

CDT - D8000-D8999 - see above

Disclaimer

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