Policy No: 36B
Originally Created: 01/01/2011
Last Reviewed: 01/01/2019
Last Revised: 01/01/2018
Surgical revision procedure, per tooth (D4268)
This procedure is to refine the results of a previously provided surgical procedure. This may require a surgical procedure to modify the irregular contours of hard or soft tissue. A mucoperiosteal flap may be elevated to allow access to reshape alveolar bone. The flaps are replaced or repositioned and sutured.
Procedures are in accordance with generally accepted standards of dental practice.
Must be over 3 years since the first procedure by the same dentist.
Procedure may be subject to review by the dental consultant.
Process to contract benefits, by report.
CDT - D4000-D4999 - see above
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