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Update to processing policy regarding frequency limitations for some diagnostic and preventive benefits

Effective June 1, 2017, we have changed the way we determine benefit eligibility for several of our diagnostic and preventive services from a rolling 12-month consecutive period to a calendar year. The calendar year begins January 1 and ends on December 31.

This update does not impact any other limitations that may be associated with the following procedures.

This update applies on the codes listed below:

D0120 Periodic oral evaluation - established patient
D0145 Oral evaluation for a patient under three years of age and counseling with primary caregiver
D0150 Comprehensive oral evaluation - new or established patient
D0160 Detailed and extensive oral evaluation - problem-focused, by report
D0180 Comprehensive periodontal evaluation - new or established patient
D0220 Intraoral - periapical first radiographic image
D0230 Intraoral - periapical each additional radiographic image
D0240 Intraoral - occlusal radiographic image
D0270 Bitewing - single radiographic image
D0272 Bitewings - two radiographic images
D0273 Bitewings - three radiographic images
D0274 Bitewings - four radiographic images
D0277 Vertical bitewings - 7 to 8 radiographic images
D1110 Prophylaxis - Adult
D1120 Prophylaxis - Child 
D1206 Topical application of fluoride varnish
D1208 Topical application of fluoride - excluding varnish 
D4346 Scaling in presence of generalized moderate or severe gingival inflammation – full mouth, after oral evaluation
D4910 Periodontal maintenance
Oral Health Oral Health

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