Preventive Section - Sealants
| Topic: Sealants |
Last Reviewed Date:
01/2003 |
| Section: Preventive |
Policy No: 10 |
| 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
Sealant – per tooth (D1351):
Mechanically and/or chemically prepared enamel
surface sealed to prevent decay.
Policy/Criteria
Procedures are in accordance with generally
accepted standards of dental practice.
Administrative Guidelines
Process to contract benefits.
Benefit available for ages 17 and under for permanent
bicuspid and molar teeth.
| Codes |
Number |
Description |
| CDT |
D1000-D1999 |
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