Categories
X Rays, exams and some tests are all included in this category.
What is Diagnostic?
This is the lower arch of the mouth.
What is Mandibular?
When the person on the phone should be advised to call a different Delta Dental. This allows us to provide the phone number.
What is the DeltaDental Phone Directory?
This is the day of the week that check run is performed and claim payments are issued.
What is Wednesdays?
These x rays share the frequency of once in 3 years or once in 5 yrs.
What is Panoramic D0330 and Full Mouth Series D0210 (FMX)?
Fillings, root canals and simple extractions are paid under this category.
What is Basic/Restorative?
This is commonly used with surgical removal of a tooth
What is General Anesthesia D9222/D9223?
When a member states that the dentist submitted a claim for services that were not performed.
What is a Billing Complaint?
This is the normal time frame for processing/ reprocessing a claim when all of the necessary information is received.
What is 7-14 business days?
Although this is a periodontal procedure, it is paid under Diagnostic/Preventive category and ALWAYS shares frequency with another periodontal procedure paid under Diagnostic/Preventive. These procedures also frequently share frequency with Prophy.
What is D4346 Scaling in the presence of generalized moderate or severe gingigval inflammation and D4910 Periodontal Maintenance?
Braces and Invisalign are part of this grouping.
What is Orthodontics?
When this procedure is done, the dentist is treating the inside of the tooth to remove infected or inflamed pulp.
What is a root canal D3330, D3320, D3310?
This benefit enhancement allows the member to carry forward a portion of unused annual maximum benefit allowance for future use
What is MaxOver/carryover?
Most providers choose this method of payment so they can receive payments more quickly.
What is Electronic Funds Transfer/ EFT?
also known as ACH
This procedure normally has an age limit of 15 and the frequency can be once per lifetime or once in 3 years or 5 years.
What are Sealants?
Crowns and bridges, partials and dentures as well as implants are part of this category.
What are Major services?
This procedure is done to maintain the space when a child loses a primary tooth.
What is a space maintainer D1510, D 1516, D1517, D1520?
This is the guideline for agents to capture all of the needed information when a member has another dental coverage.
What is Creating a COB Issue Information checklist?
found in QRGs/COB folder
This document is produced with every claim payment.
What is EOB/Explanation of Benefits?
(this is not a bill)
This procedure does not appear on the Limitations Summary page but commonly shares the same frequency as exams.
What is a Consultation D9310?
This type of procedure is normally with Basic and sometimes with Majors.
What is Periodontics?
This procedure would include retainer crowns and a pontic.
What is a Bridge/fixed prosthodontic?
When a person is born without certain teeth
What is congenitally missing tooth/teeth?
When a member/patient needs a Major service or Periodontal services, the dentist should request this.
What is a Predetermination/pre -d?
This limitation is that treatment is not allowed the same day as this procedure.
What is Palliative treatment D9110?