Orthodontics

Delta Dental’s allowance for orthodontic procedures includes all appliances, adjustments, insertion, removal and post-treatment stabilization (retention).

Orthodontic Treatment Claims

Be sure to include:

  • Total fee (including the initial fee/down payment and monthly payment amounts)
  • Banding date
  • Type of appliance
  • Total length of active treatment
  • Brief description of the dentition, appliance and treatment

Dual Coverage

When Delta Dental is secondary in dual coverage cases, please include the primary coverage’s total liability including copayment/coinsurance percentage and the explanation of benefits (EOB).

Work-in-Progress

Include the amount paid by the previous carrier on the claim.

Specialized Orthodontic Appliances

How should we submit claims for clear aligners?

Charges for clear aligners (e.g., Invisalign®, SureSmile®) should be submitted using the appropriate orthodontic procedure code (D8010-D8090). The benefit is based on the approved fee for conventional orthodontics. Any additional fee for the non-traditional method is not billable to the patient.

Note: With some DeltaCare® USA plans clear aligners are excluded treatment.