Audience
Zip code - drawer
County - drawer

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Policy No:  54B

Originally Created: 01/01/2001

Section: Orthodontics

Last Reviewed:  01/01/2019

Last Revised:  01/01/2018

Approved: 01/01/2018

Effective:  01/01/2018

Description

Replacement of lost or broken retainer (D8692)

Policy/criteria

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

Administrative guidelines

Process to orthodontic benefit.

Not a covered benefit if there is a contract exclusion for lost or stolen appliances.

Codes

CDT - D8000-D8999 - see above

Disclaimer

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.