Blue Cross Blue Shield FEP Dental
Section 5 Dental Services and Supplies Class A Basic
Section 5 Dental Services and Supplies Class A Basic
Additional Procedures Covered as Basic Services
D9110 Palliative treatment of dental pain – per visit - Not covered the same day as final treatment
D9310 Consultation (diagnostic service provided by dentist or physician other than requesting dentist or physician)
D9311 Consultation with a medical health care professional
D9440 Office visit after regularly scheduled hours
Class A Basic Notes:
D9310 Consultation (diagnostic service provided by dentist or physician other than requesting dentist or physician)
D9311 Consultation with a medical health care professional
D9440 Office visit after regularly scheduled hours
Class A Basic Notes:
- All exams, oral evaluations and treatments such as fluorides are combined under one limitation under the plan. For example, periodic oral exam (D0120), oral evaluations (D0140), and comprehensive oral exam (D0150, D0180) are combined and limited to two examinations per year. If you have two exams and/or oral evaluations on the same date of service by the same dentist or dental office, only one of the exams will be reimbursed.
- Prophylaxis and scaling in presence of generalized moderate or severe gingival inflammation:
- Limit 3 during the calendar year for any combination of D1110, D1120, and D4346, age 13 and under will be processed as D1120 and age 14 and over will be processed as D1110.
- Limit 3 during the calendar year for any combination of D1110, D1120, and D4346, age 13 and under will be processed as D1120 and age 14 and over will be processed as D1110.
- One comprehensive evaluation per provider’s office; additional comprehensive evaluations will be processed as a periodic evaluation
- 14 or more radiographic images on the same date of service will be processed as a D0210 (complete set of radiographic images). Bitewing radiographic images with the same date of service as a Panoramic radiographic image will be processed as a D0210.