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Claim Administration Policies

Claim Administration Policies

CodeDescriptionEffectiveUpdate
D0210Intraoral - complete series of radiographic imagesMarch 2017To align with the ADA descriptor of D0210, additional intraoral periapical D0220 & D0230 and bitewing radiographic images D0270, D0272, D0273, D0274 and D0277 will not be separately eligible when performed on the same date of service as D0210.
D3310, D3320, D3330, D3331, D3332 & D3333Endodontic therapy with intraoral periapical radiographic imagesMarch 2017To align with the ADA nomenclature for endodontic therapy, periapical radiographic images D0230 will be denied when performed in conjunction with endodontic therapy on the same date of service. D0230 is part of the endodontic therapy. Diagnostic evaluation and images are not part of the endodontic therapy.
D0277Vertical bitewings - 7 to 8 radiographic imagesMarch 2017Bitewing radiographic images D0270, D0272, D0273 & D0274 will be denied when performed on the same date of service as D0277.
D4355Debridement, full mouth to enable comprehensive periodontal evaluation and diagnosisMarch 2017

To align with the ADA descriptor of D4355, the following changes are being made to our claim processing policies:

  • D4355 will be denied when performed on the same date of service as D0120.
  • D0145, D0150, D0160 and D0180 will be denied when performed on the same date of service as D4355.
  • D1110, D1120, D4910, D4341, D4342 and D4346 will be denied when performed on the same date of service as D4355.
D4910Periodontal maintenance and D431/D4342 Periodontal scaling and root planning
March 2017The descriptor for D4910 periodontal maintenance includes removal of bacterial plaque and calculus from supragingival and subgingival regions, site specific scaling and root planning as well as polishing where indicated. D4341/D4342 periodontal scaling and root planing is not separately eligible when performed on the same day as a D4910.
D3310, D3320 & D3330Endodontic therapyMarch 2017Claims submitted for D3310, D3320 or D3330 will be denied if there is a history of Root Canal Therapy on the same tooth. Endodontic retreatment should be submitted under codes D3346, D3347 & D3348 for consideration.
D3910Surgical Procedure for Isolation with Rubber DamMarch 2018

D3910 and D3950 are no longer separately eligible procedures when performed in conjunction with endodontic therapy on the same date of service.

D3950Surgical Procedure for Isolation with Rubber DamMarch 2018D3910 and D3950 are no longer separately eligible procedures when performed in conjunction with endodontic therapy on the same date of service. 
D2940Protective Restoration Direct placement of a restorative material to protect tooth and/or tissue form. This procedure may be used to relieve pain, promote healing, or prevent further deterioration. Not to be used for endodontic access closure, or as a base or liner under a restoration.  September 2018D2940 is no longer a separately eligible procedure when performed in conjunction with endodontic therapy on the same date of service.  This procedure is included in the primary procedure and is therefore considered incidental to that procedure and does not warrant separate reimbursement.  Members should not be billed for this service.
D7260Oroantral Fistula Closure Excision of fistulous tract between maxillary sinus and oral cavity and closure by advancement flap.September 2018According to ADA CDT code nomenclature, D7260 - Oroantral Fistula Closure should not be billed when repairing a perforation on the same date as an extraction. The correct code would be D7261 – Primary Closure of a Sinus Perforation.  Aetna will not reimburse D7260 when billed in conjunction with extraction(s) on the same date of service.
D7261Primary Closure of a Sinus Perforation Subsequent to surgical removal of tooth, exposure of sinus requiring repair, or immediate closure of oroantral or oralnasal communication in absence of fistulus tract.September 2018D7261 is a separately eligible procedure when performed in conjunction with extraction(s) on the same date of service.
D4320D4320 – Provisional Splinting- Intracoronal - This is an interim stabilization of mobile teeth.  A variety of methods and appliances may be employed for this purpose.  Identify the teeth involved.September 2018D4320 and D4321 will no longer be reimbursed per tooth, but per span.   Please include the teeth numbers within the span when submitting either of these codes
D4321Provisional Splinting- Extracoronal - This is an interim stabilization of mobile teeth.  A variety of methods and appliances may be employed for this purpose.  Identify the teeth involved.September 2018D4320 and D4321 will no longer be reimbursed per tooth, but per span.   Please include the teeth numbers within the span when submitting either of these codes

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