FYI

Did you know a very common reason for claim denials is missing documentation? As a Delta Dental dentist, it is essential to submit the necessary documentation with claims for specific procedure codes. Claims lacking the required documentation will be denied.

Our data review identified three common procedures that get denied due to missing documentation. To ensure smooth processing and payment of your claims, please review this information.
 
Inlays, onlays and crowns (D2510-D2664, D2710-D2794)
Required documentation:

1. Periapical radiograph — pre-operative radiograph showing the endodontic/periodontal state of the tooth taken within one year of the crown prep procedure. To avoid delays, please ensure the image depicts the entire tooth, including the root tip. Please do not substitute a panoramic radiograph to replace this periapical image.
2. Photographs — any available.

Note: Lab slips should be maintained as part of the patient record.
 
Periodontics (D4210-D4212, D4240-D4245, D4260-D4285, D4341-D4342, D4381)
Required documentation:

1. Bitewing or periapical radiographs — bitewing radiographs taken within 12 months of the planned treatment that show both arches of bone levels, or periapical radiographs. Loss of alveolar crest height beyond the normal 1-1.5 millimeter distance to the cementoenamel junction (CEJ) must be evident on radiographs.
2. Periodontal charting — done within the past 12 months
3. Chart notes — including periodontal stage and grade, regarding the necessity of the periodontal treatment

 
Oral surgery (D7210-D7241, D7250, D7251, D7252)
Required documentation:

1. Periapical or panoramic radiographs — that reflect the current anatomical position and the amount of bone surrounding the tooth. For code D7251, pre and post-operative radiograph.
2. Chart notes — detailed tooth specifics regarding the necessity of the treatment
3. Photographs — any available

For more documentation lists for other procedures and further information on Claims Processing Policies and Procedures, Procedure Codes that Require Documentation Submission, refer to the Provider Handbook in Provider Tools.