When to Send X-rays

Procedures That Require X-rays, Perio Charts or Narratives

X-rays

X-rays only need to be included for the following procedures:

Restorative

  • (D2710 - D2794) Crowns – laboratory processed
  • (D2950) Core buildup, including any pins

Implant services

  • (D6055 - D6077) Implant supported prosthetics

Prosthodontics, fixed

  • (D6710 - D6794) Fixed partial denture retainers – crowns

Other Documentation

Periodontal charting is necessary for osseous and other periodontal surgery procedures in these procedure codes:

  • D4210 - D4212
  • D4240 - D4245
  • D4260 - D4278
  • D4381

A copy of the pathology report is needed for hard and soft tissue biopsies:

  • D7285 - D7286

Please submit the operative and pathology reports for the following procedures:

  • D7410 - D7415
  • D7440 - D7461
  • D7465

A copy of the operative report is needed for procedures:

  • D7490 - D7521
  • D7610 - D7780
  • D7910 - D7912
  • D7980 - D7983 and D7998

Narratives need to be included for procedures: D2950, D2980 (with copy of lab bill), D4249, D4320, D4321, D4920, D5620, D7260, D7530, D7540, D8210, D8680 and D9930 as well as any exceptional cases and the unspecified codes in all categories of service (D##99). Enter the information in the “Remarks” or “Comments” field.

An itemized Explanation of Benefits is required for all procedures when Delta Dental is the secondary carrier.

  • During clinical review of claims and pre-treatment estimates, Delta Dental reserves the right to request radiographic images and/or documentation for procedures that otherwise may be identified as not requiring the submission of documentation.
  • 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.

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