Typical to send with Claims

Question 1

Periodontal Maintenance D4910

Answer 1

SRP dates with quads included, perio charting, chart notes/narrative

Xrays:
PAN/BW or ANT PA/PAN or ANT PA/BW or FMX, anesthesia used, time spent with patient

Question 2

Crown

Answer 2

Narrative/chart notes, PA and IOC of tooth, initial or replacement, (if replacement, est date it was previously done) reason why it was done, anesthesia used

Question 3

Bridge

Answer 3

Narrative/chart notes, PA IOC PAN, Perio Chart, tooth chart, initial or replacement, (if replacement, est date it was previously done), reason why it was done, list of missing teeth (all missing teeth), anesthesia used

Question 4

Denture

Answer 4

Narrative/chart notes, PA IOC PAN, Perio Chart, tooth chart, initial or replacement, (if replacement, est date it was previously done), reason why it was done, list of missing teeth (all missing teeth), anesthesia used

Question 5

SRP D4341/D4342

Answer 5

Perio charting, chart notes/narrative, anesthesia used, time spent with pt

Xrays: PAN/BW and ANT PA/PAN or ANT PA/BW or FMX

Question 6

Ortho

Answer 6

Banding date, estimated amount of treatment weeks, measurements

Question 7

Onlay

Answer 7

Conservative alternative to a full surface crown. Used to replace the defective cusps.

List the cusps, narrative/chart notes, PA and IOC of tooth, initial or replacement (if replacement, est date it was previously done), reason why it was done, anesthesia used

Question 8

Occlusal Guard D9944

Answer 8

Reason occlusal guard was necessary. Send w/ PAN

Question 9

Endo

Answer 9

Chart Notes/narrative, PA, IOC’s, anesthesia used (include length of canal).