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Claim Documentation Guidelines Update2 - Aetna

Proprietary DENTAL AND ORAL SURGERY Claim Documentation Guidelines Each benefits plan defines which services are covered, excluded and subject to dollar caps or other limits. Members and their dentists will need to refer to the member's benefits plan to determine if any exclusions or other benefit limitations apply. In addition, coverage may be mandated by applicable state or federal legal requirements. Unless otherwise noted, all services must be submitted using valid and current Dental Procedures and Nomenclature (CDT ) codes.

Sep 30, 2019 · radiographs and/or panoramic radiograph Extraction dates of teeth to be replaced Date of prior prosthetic placement (fixed and/or removable dentures, if applicable) Numbers of all missing teeth Tooth number of proposed implants D6052-D6079. D6082-D6088, D6094-D6099, D6194, D6110­ D6117, D6120-D6123, D6195 Current dated full mouth pre-operative

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