2010 Processing Policy Changes

As a member of Delta Dental Plans Association (DDPA) we look for ways to provide greater consistency across our national Delta plans. At Washington Dental Service we are continually reviewing our processing policies in order to align our policies more closely with the DDPA thus ensuring consistent, seamless coverage for our members no matter where they receive their treatment.

Effective May 1, 2010 we are implementing the following treatment policy changes:

• A comprehensive oral evaluation (D0150/D0160/D0180) is covered once for the same patient by the same dentist. This complies with the ADA’s definition of a comprehensive oral evaluation. Exceptions can be made on a “by report” basis, if the patient meets the criteria outlined by the ADA (an established patient who has had a significant change in health or other unusual circumstances, or an established patient who has not been seen in your office for three years or more).
• Limited problem focused evaluations (D0140/D0170) are covered twice per benefit period.
• A problem focused evaluation (D0140/D0160/D0170) within 30 days of any surgical treatment by the same dentist is disallowed as a component of the surgical treatment.
• Root canal treatment includes all intra-operative x-rays. Washington Dental Service will allow one diagnostic x-ray and disallow all treatment x-rays taken in conjunction with root canal treatment.
• Retreatment of root canal treatment by the same dentist within two years is considered part of the original treatment and is disallowed.
• The time limitation on indirect restorations applies to crowns on implants, crowns on natural teeth, onlays, porcelain veneers and fixed partial denture units. If a crown is placed on a natural tooth and a subsequent implant crown is placed before the time limitation, the implant crown will be denied and made patient responsibility.
• Inlays that are made elective to amalgams will have a time limitation equal to the amalgam, typically two years. In the past, inlays were held to the same time limitation as crowns even when made elective to an amalgam.

For more detailed information on Washington Dental Service and DDPA processing policies, member dentists can refer to the Washington Dental Service Processing Policy manual and the DDPA Dentist Handbook.