Restorative - Provisional Crown
| Topic: Provisional
Crown |
Last Review Date: 01/2003
|
| Section: Restorative |
Policy No: 16A |
| 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
Provisional crown (D2799):
Crown utilized as an interim restoration of at least
six months duration during restorative treatment to
allow adequate time for healing or completion of other
procedures. This includes, but is not limited to,
changing vertical dimension, completing periodontal
therapy or cracked tooth syndrome. This is not to
be used as a temporary crown for a routine prosthetic
restoration.
Policy/Criteria
Procedures are in accordance with generally
accepted standards of dental practice.
Administrative Guidelines
Process to contract benefits.
Procedure is by report with supporting documentation.
| Codes |
Number |
Description |
| CDT |
D2000-D2999 |
|
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|
