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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



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.

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.


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.