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For Dentists

Claims Review

Our consultants are on hand to quickly and thoroughly review paper claims and predeterminations.

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Please submit the following documentation when submitting claims for the services listed:

 

Onlays, Veneers & Crowns   Recent periapical X-ray that displays the tooth apex
Root Canal Retreatment   Pre-retreatment periapical radiograph, reason for retreatment and date of original root canal
Scaling/Root Planing, Osseous Surgery, Gingivectomy   Recent periodontal charting and full mouth series or panorex
Soft Tissue Grafting   Recent periodontal charting and narrative indicating amount of remaining attached gingival
Crown Lengthening   Recent pre-operative periapical X-ray
Implants Recent pre-operative full mouth series or panorex
Fixed and Removable Prosthesis   Recent pre-operative full mouth series or panorex, if a replacement — age of previous prostheses and reason for replacement
Core Build Up and Post and Core Pre-operative X-ray for core build up and post-root canal therapy X-ray for post and core

 

In addition, please remember:

  • To avoid delays in claim reimbursement, CDT codes D7230, D7240 and D7241 require the submission of a medical EOB.
  • Always send readable X-rays. If the image is not clear to you, it will also be difficult for the reviewer to read.
  • Never submit your original X-rays. Submit duplicates or use double film packets.
  • If necessary, please include a narrative in support of the requested service.
  • Indicate which teeth are missing in the arch in the "Missing Tooth" section of the claim form.