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2018 - LIBERTY Dental Plan

2018 Clinical Criteria, guidelines and Practice parameters CLINICAL DENTISTRY guidelines Clinical Criteria guidelines Page 2 of 22 PREFACE LIBERTY Dental Plan s Clinical Criteria guidelines and Practice parameters were originally developed in 2005 and are subject to periodic revisions and annual review by the QMI Committee and Board of Directors. The criteria document was developed internally by our Dental Directors with input from participating panel general dentists and specialists. LIBERTY utilizes the American Dental Association s Dental Practice parameters , sound Dental clinical principles, processes and evidence to consistently evaluate the appropriateness of Dental services that require review.

CLINICAL DENTISTRY GUIDELINES Clinical Criteria Guidelines v.20180109 Page 2 of 22 PREFACE LIBERTY Dental Plan’s Clinical Criteria Guidelines and Practice Parameters were originally developed in …

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