Oral and Maxillofacial Surgery Section, TRG Dental Policy

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Oral and Maxillofacial Surgery Section - Tooth Transplantation

Topic: Tooth Transplantation	Last Reviewed Date: 01/2003
Section: Oral and Maxillofacial Surgery	Policy No: 45
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
Tooth transplantation:

Includes reimplantation from one site to another and splinting and/or stabilization (D7272)

Policy/Criteria
Procedure is in accordance with generally accepted standards of dental practice.

Administrative Guidelines
By report procedure with supporting documentation.

Codes	Number	Description
CDT	D7000-D7999

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	The Blue Cross and/or Blue Shield Plans comprising The Regence Group serve Idaho, Oregon, Utah and much of Washington state. The Regence Group and each of its affiliate Plans are independent licensees of the Blue Cross and Blue Shield Association.