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When to send x-rays
Determining the type of documentation
to send with your claim
Approximately one-third
of the claims Delta receives with x-rays do not
require x-rays for Delta to make its claim evaluation.
Unnecessary submission of x-rays can be costly and
time-consuming for the dental office, and may actually
delay processing of your claim.
Usually, Delta requires
x-ray documentation (or in some cases periodontal
charting) only for the procedures listed below.
On occasion, a dental consultant may deem it necessary,
given the circumstances of a particular case,
to request x-rays for procedures that are not
on this list. X-ray documentation is requested
only when absolutely necessary for determining
benefits. If you don't need to have your x-ray
copies returned, place "do not return"
stickers on the x-ray mount.
Order free stickers by writing
to:
Delta Dental Insurance Company
Professional Services Department
1000 Mansell Exchange West
Building 100, Suite 100
Alpharetta, GA 30022
Procedure codes that require
x-ray submission
Restorative
| 02335 |
Resin-four
or more surfaces or involving incisal (anterior) |
| 02510-02652 |
Inlays/onlays-metallic;
porcelain/ceramic; composite/resin |
| 02710-02810 |
Crowns-resin;
cast |
| 02950 |
Crown buildup
(substructure), including any pins |
| 02960-02962 |
Labial
veneers |
Endodontics
| 03460 |
Endodontic
endosseous implant |
Periodontics
| 04249 |
Crown
lengthening-hard and soft tissue, by report |
Prosthodontics, fixed
| 06030-06199 |
Implants |
| 06520-06540 |
Inlays/onlays
|
| 06545 |
Retainer
for acid-etch retained bridge |
| 06750-06792 |
Bridge retainers-crowns
|
| 06973 |
Retainer
crown buildup (substructure) including any pins |
Oral surgery
| 07130 |
Root
removal-exposed roots |
| 07210-07250 |
Surgical
removal of erupted/impacted tooth, tooth roots
|
| 07260-07272 |
Other
surgical procedures |
| 07450-07461 |
Removal of
odontogenic/nonodontogenic cyst or tumor |
| 07540 |
Removal
of foreign bodies-musculoskeletal system |
| 07550 |
Sequestrectomy
for osteomyelitis |
| 07560 |
Maxillary
sinusotomy |
| 07610-07680 |
Simple fractures |
| 07710-07780 |
Compound
fractures |
| 07940-07949 |
Osteoplasty/osteotomy/LeFort
I, II and III |
| 07980-07981 |
Saliolithotomy/excision
of salivary gland |
| 03460 |
Endodontic endosseous
implant |
|
06030-06199 |
Implants |
Procedure codes that require
periodontal charting only; do not send x-rays unless
specifically requested
| 04210-04220 |
Gingivectomy
or gingivoplasty/gingival curettage |
| 04240 |
Gingival
flap procedure, incl. root planing-quad |
| 04260 |
Osseous
surgery-per quadrant |
| 04341 |
Periodontal
root planing-per quadrant |
Back
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