Miscellaneous Section - Multiple Surface
Restorations, Same Tooth
| Topic: Multiple Surface
Restorations, Same Tooth |
Last Reviewed Date:
01/2003 |
| Section: Miscellaneous |
Policy No: 67B |
| Revised/Effective Date: 01/2003
|
Next Review Date: 01/2004 |
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
Multiple Surface Restorations, Same Tooth:
A multiple surface restoration is one which restores
more than one surface of a tooth.
Policy/Criteria
Procedure is in accordance with generally accepted
standards of dental practice.
Administrative Guidelines
Process to contract benefits.
Surfaces that are contiguous should be processed as
a single restoration. Restoration surfaces not contiguous
should be processed as a separate restoration. Apply
policy to molars and bicuspids and do not apply to anteriors.
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