Diagnostic procedures to aid the Provider in determining required dental treatment.
Diagnostic testing and treatment related to Attention Deficit Hyperactivity Disorder (ADHD) are covered subject to Medical Necessity and utilization management guidelines. Covered Services do not include those that are primarily educational or training in nature.
Diagnostic preventive, and medically necessary follow-up care to treat a dental disease, illness, injury or disability of members while they are enrolled in the HMO.
Diagnostic. D0999 Unspecified diagnostic procedure, by report No cost No Cost Includes office visit, per visit (in addition to other services) Includes office visit, per visit (in addition to other services) D0120 Periodic oral evaluation - established patient No cost No Cost 1 of (D0120, D0150, D0180) per 6 months D0140 Limited oral evaluation - problem focused No cost No Cost 1 of (D0140, D0170) per Contract Dentist per 6 months D0145 Oral evaluation for a patient under three years of age and counseling with primary caregiver No cost Not a benefit D0150 Comprehensive oral evaluation - new or established patient No cost No cost 1 of (D0120, D0150, D0180) per 6 months D0160 Detailed and extensive oral evaluation - problem focused, by report No cost No cost D0170 Re-evaluation - limited, problem focused (established patient; not post-operative visit) No cost No cost 1 of (D0140, D0170) per Contract Dentist per 6 months D0171 Re-evaluation - post-operative office visit Not a benefit $5 D0180 Comprehensive periodontal evaluation - new or established patient No cost No cost 1 of (D0120, D0150, D0180) per 6 months D0210 Intraoral - complete series of radiographic images No cost No cost 1 series per 60 months 1 series per 24 months D0220 Intraoral - periapical first radiographic image No cost No cost D0230 Intraoral - periapical each additional radiographic image No cost No cost D0240 Intraoral - occlusal radiographic image No cost No cost D0250 Extra-oral - 2D projection radiographic image created using a stationary radiation source, and detector Not a benefit No cost D0270 Bitewing - single radiographic image No cost No cost 1 set per 6 months Code Description Pediatric Enrollee Cost Share1 Adult Enrollee Cost Share2 Clarification/ Limitations for Pediatric Enrollees Clarification/ Limitations for Adult Enrollees D0272 Bitewings - two radiographic images No cost No cost 1 set per 6 months D0273 Bitewings - three radiographic images No cost No cost 1 set per 6 months D0274 Bitewings - four radiographic images No cost No cost 1 set per 6 months 1 series per 6 months D0277 Vertical bitewings - 7 to 8 radiographic images No cost No cost 1 set per 6 months D0330 Panoramic radiographic image No cost No cost 1 image per 60 months D0340 2D cephalometric radiographic image - acquisition, measurement and analysis No cost Not a benefit D0350 2D oral/facial photographic image obtained intra-orally or extra-orally No cost Not a benefit D0391 Interpretation of diagnostic image by a pra...
Diagnostic or monitoring equipment purchased for home use, unless otherwise described as a Covered Health Care Service.
Diagnostic. Research undertaken by OVH at the Customer’s request to identify a malfunction problem of the Service.
Diagnostic preventive, and medically necessary follow-up care to treat a dental disease, illness, injury or disability of members while they are enrolled in the PIHP.
Diagnostic x-rays, electrocardiograms (ECG), electroencephalograms (EEG), laboratory testing and pathological examinations when performed by a Physician for the diagnosis of an Illness or Injury. U. Imaging (i.e.radiation therapy, MRI, CT/PET Scans) and Treatments with other radioactive substances.
Diagnostic. Oral evaluations are covered one time in a period of six (6) months. Evaluations can be comprehensive, limited, or periodic and may be provided by a specialist or a general Dentist. Limited oral evaluations. Radiographic images are covered with limitations. Complete series or panoramic image are covered once in a period of five (5) years. Bitewing images are covered once in a period of six (6) months. Images of individual teeth are covered as necessary. Caries risk assessment is covered one time in a period of three (3) years for Pediatric Members between the ages three (3) and nineteen (19).
Diagnostic. Requisition diagnostic testing as prescribed. Insure lab in aware of requested tests and fill out appropriate documentation. Aid lab with test pre-preparation, performance of procedures, and follow up if necessary. Ensure physician is aware of test results.
