Policy No: 67B
Originally Created: 01/01/1999
Last Reviewed: 01/01/2019
Last Revised: 01/01/2018
Multiple Surface Restorations, Same Tooth
A multiple surface restoration is one which restores more than one surface of a tooth.
Procedure is in accordance with generally accepted standards of dental practice.
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.
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.