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Zip code - drawer
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Policy No:  39

Originally Created: 01/01/2011

Section: Prosthodontics

Last Reviewed:  01/01/2019

Last Revised:  01/01/2018

Approved: 01/01/2018

Effective:  01/01/2018

Description

Surgical placement of implant body: endosteal implant (D6010)

Surgical placement of mini implant (D6013)

Policy/criteria

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

Placement of mini implants are not a benefit of the dental contract.

Prefabricated or custom fabricated abutments are not a covered benefit if the implant is not covered.  Crowns supported by an implant are a covered benefit regardless whether or not the implant was covered.

There are no additional benefits for supplemental procedures such as bone grafts, tissue grafts or membranes or sinus lift procedures.

Administrative guidelines

Process to contract benefits.

 

Codes

CDT - D5000-D6999 - 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.