In our December 2022 Newsletter, we shared information to help you get better results from your claims submissions, ensure timely claims payments, and increase satisfaction.

Since that time, we have received follow-up questions, many of which are related to radiographs and crowns. As we noted then, all radiographs need to be of good diagnostic quality and appropriate to the procedure requested. A radiograph that is not readable may result in a claim denial for information.

Specific to crowns, these claims must include a periapical film that clearly shows the entire tooth under treatment, including the root tip. A bitewing is also helpful, though not required. Panoramic films are not adequate as they do not consistently clearly show individual tooth structure and pathology. Additional information is welcomed and could include a narrative and/or an intraoral photograph. Both could potentially provide additional information beyond what is available in a radiograph. 

Finally, as always, pre-determinations for crowns or any other procedure exceeding $250 are highly recommended. Pre-determinations allow dentists to review proposed treatment with a patient and make decisions before proceeding. Financial arrangements can be made in advance, and potential confusion can be avoided. Perhaps most importantly, there is less risk of a surprise when the procedure is completed, and the claim is submitted.

Providing crown submissions that include a clear, diagnostic periapical radiograph, along with relevant supporting information, will go a long way toward avoiding denials for information and other claim delays. 

Michael D Weitzner, DMD, MS

Dental Director, Delta Dental of Virginia