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The Regence Group Dental Policy
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Oral and Maxillofacial Surgery Section - Alveolus

Topic: Alveolus Last Reviewed Date:  01/2003
Section: Oral and Maxillofacial Surgery Policy No: 52A
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

Alveolus, open reduction, may include stabilization of teeth (D7671):
Teeth may be wired, banded or splinted together to prevent movement.

Alveolus, closed reduction stabilization of teeth (D7771):
Fractured bone(s) are exposed to mouth or outside the face.

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

Administrative Guidelines
Process to dental benefits.

Codes Number Description
CDT
D7000-D7999  

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