Adjunctive General Services Section - Desensitizing
Medicaments
| Topic: Desensitizing Medicaments |
Last Reviewed Date: 01/2003 |
| Section: Adjunctive General Services |
Policy No: 58 |
| Revised/Effective Date: 01/2003
|
Next Review Date: 01/2005 |
IMPORTANT INFORMATION
This Dental Policy has been developed through consideration of
generally accepted standards of dental practice, review of dental literature,
dental necessity, and as appropriate, government approval.
Benefit determinations should be based
in all cases on the applicable contract language.
To the extent there are any conflicts between these guidelines and the
contract language, the contract language will control.
The purpose of dental policy is to provide a guide to coverage. Dental
policy is not intended to dictate to providers how to practice dentistry.
Providers are expected to exercise their clinical judgment in providing
the most appropriate care.
|
Description
Application of desensitizing medicament (D9910):
Includes in-office treatment for root sensitivity.
Typically reported on a "per- visit" basis
for application of topical fluoride. Typically reported
on a "per-tooth" basis for application of
adhesive resins. This code is not to be used for bases,
liner or adhesives used under restorations.
Application of desensitizing resin for cervical
and/or root surface, per tooth (D9911):
Typically reported on a "per-tooth" basis
for application of adhesive resins. This codes is
not to be used for bases, liners or adhesives used
under restorations.
Policy/Criteria
Procedure is in accordance with generally accepted standards
of dental practice.
Administrative Guidelines
Process to contract benefits.
A separate allowance is not covered if billed in conjunction
with another procedure on the same tooth for the same
day.
Note: D9910 or D9911 are the appropriate codes
for brush varnish for sensitivity purposes. Usually
billed for adult patients.
| Codes |
Number |
Description |
| CDT |
D9000-D9999 |
See above |
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