There are a number of categories of procedures that require a radiographic image to allow for appropriate claim review. The following are the most common procedures that when radiographs are submitted the claim processing and turnaround are improved.
Scaling and root planing (D4341, D4342): Bone loss is the primary requirement for approving a claim for scaling and root planing. Bite-wing radiographs are the best image to display the bone level around teeth. Bite-wing radiographs should be submitted for every claim that includes scaling and root planing. Without bite-wing radiographs the claim for scaling and root planing cannot be reviewed.
Crowns and Build ups (all crown codes: D2720 – D2794; and D2950): Crowns are a benefit when the amount of tooth structure lost cannot be repaired by any other means. Build ups are a benefit when the amount of tooth structure remaining is not sufficient to provide retention for a crown. A periapical radiograph provides the most information regarding the loss of tooth structure and the health of the remaining tooth. Photographic images also provide significant information regarding the amount of tooth structure that has been lost. Submission of either or both of these images will greatly improve claims processing and turnaround time.
Extractions (D7140 – D7250): Extraction codes are categorized for the most part by the position of the tooth and the surrounding tissue and/or bone. The surrounding bone is the most important element in determining the most appropriate extraction code to use. A radiographic image (periapical radiograph or panoramic radiograph) can provide a clear representation for the position of the tooth with respect to the surrounding bone. Claims submitted with diagnostic quality radiographs are processed much quicker than claims submitted with radiographs.
