When to Send X-rays and Other Documentation
Procedures That Require X-rays, Perio Charts or Narratives
X-rays only need to be included for the following procedures:
- (D2710 - D2794) Crowns – laboratory processed
- (D2950) Core buildup, including any pins
- (D6055 - D6077) Implant supported prosthetics
- (D6710 - D6794) Fixed partial denture retainers – crowns
Periodontal charting needs to be included for the following procedures:
- (D4260 - D4276) Osseous and other periodontal surgery
Include a copy of the pathology report for hard and soft tissue biopsies:
- (D7285 - D7286) Biopsies
Narratives need to be included for any unspecified code in all categories of service:
- (D##99)Unspecified procedure, by report
Itemized Explanation of Benefits from the Primary Carrier
An itemized Explanation of Benefits needs to be included when Delta Dental is the secondary carrier:
- All procedure codes
- These guidelines apply to your Delta Dental Premier and Delta Dental PPO patients with coverage through or administered by Delta Dental Insurance Company (Alabama, Florida, Georgia, Louisiana, Mississippi, Montana, Nevada, Texas and Utah) and Delta Dental of California, Delta Dental of Delaware, Delta Dental of the District of Columbia, Delta Dental of New York, Delta Dental of Pennsylvania/ Maryland and Delta Dental of West Virginia.
- Current Dental Terminology (CDT)© American Dental Association (ADA). All rights reserved.
Why We Need Supporting Documentation
Most of the claims we get don't need documentation, but for some procedures, supporting documentation such as x-rays or charts help us determine if treatment is covered under the patient's benefit plan. For example, a consultant reviews a preoperative x-ray when a claim is received for a cast restoration to see if the contractual criterion has been met for coverage: that so much tooth structure has been lost from caries or fracture that a direct amalgam or resin restoration would not be an adequate restoration.