BENEFIT BREAKDOWN
What is the full breakdown for Sealant (per tooth) including the code. Out-of-network (OON) Hyang
D1351 Preventative 100%
Does not apply to ded or max
Eligible for dep. children to age 14
1 treatment every 3 rolling yr on permanent molars only.
What service was performed on Date of Service (DOS) 06/09/2021 & What is the tooth #? MM Donald
D2740 on th# 03
Which Flag is expired? Dr. Hoag
PRIVCON Medicare Opt Out Flag
What's the Rate using FEE 918 for code D2950, zip 06156, PCD, 01/14/2026, INN
$169
I need to verify this EVERY DAY. Where can I find it?
Start my Day
CS Tool/Folder - Start my Day
Please provide a full breakdown for D4910 in-network (INN) Hyang
D4910 Basic 80%
Ded: 50 not met; Max 1,500 nothing used
Perio maintenance combined with prophy freq. 2 per calendar yr
026- Dental Frequency Met
On EPDB, What language does the dentist speak? Dr. Hoag
English
What's the rate? INN
FEE 5HV, Zip 06156, Endo, D3310, 01/14/2026
$570
Does MM Hyangs account issue cards?
If yes, what do we need to do to send it.
If no, what other options do they have.
No
They can access the digital card on Aetna.com or we can issue a Welcome letter with the digital card.
Please provide the full breakdown of benefits for a D3320 in-network (INN) MM Hyang
D3320 Basic 80%
Ded: $50 - Not met
Max: $1,500 - Nothing used
No freq.
Claim EQJNSQ95Q00 why did Aetna only pay $433.80? Why is the member bill $466.20?
MM met the Maximum
What's the dentists Specialty and what's the Credentialed Effective Date? Dr. Hoag
Periodontics - 01/01/1970
Using your CS Toolbar/Folder, What's the rate for a Specialist under Fee 676, Code D7250?
$177
What are the Claim Documentation Guidelines for D4341/D4342?
*Current dated pre-operative periodontal charting
*Current dated pre-operative radiographs
*Chart Notes that include administration of local anesthetic and details regarding the treatment performed (in writing)
*Length of appointment
Please provide the full breakdown for code D5120 in-network (INN) Hyang
D5120 Major 50%
Ded: $50 - not met ; Max: 1,500 - Nothing used
7 year rule for prosth replacement; Miss Th applies, except congenitally miss
Hyang EA37R4F4X00, Why hasn't payment been released.
This is a pre-determination.
On EPDB, What University did the dentist attend and what year did they graduate? Dr. Hoag
Tufts University - 2013
TIN: 823992542 Dr. Hemanth Sahukar 9931 PPO. What's the fee?
CAR058
Group Number: 101938 Plan PD Assignment of Benefits
Who will we pay the claims to?
This is a direct member reimbursement plan. All benefit payments are issued to the member.
Please provide the full breakdown for code D2740 on th 18 in-network (INN) Hyang
D2740 Major 50% Downgrades on th18 to D2792.
Ded: 50 not met; Max: 1,500 not used
7 yr rule applies, Miss th applies, except congenially miss.
EFADR6JPQ00 Why did Aetna NOT pay for D0230?
It applied to the deductible.
How does the pv get paid? Where can I find that? Dr. Girgius
EFT - BMO BANK
GPS CAP OFFICE/PBG
What's the Fee?
TIN: 474211536 Dr. John H Payne 2600 Bell Rd Montgomery AL 36117 PPO
DGP - GUA127/128
D1516 Can this be done on a permanent tooth?
No - Deny service with action code A35.
CS Tool/Folder - e. policies - ADA Code Listing - D1516