Welcome to our first newsletter of 2024! We're excited to provide essential updates and resources to streamline your claim submissions, keep you informed on updated CDT codes, introduce you to our expanding network of members and much more!

We've moved!

Managing Claim Submissions for

Scaling & Root Planing

Delta Dental of Virginia continuously monitors network feedback, looking for ways to improve its processes and procedures and to find opportunities to better communicate with our dentists. One procedure that raises many questions is scaling and root planing. This article provides suggestions to help streamline claim submissions for scaling and root planing procedures.

D4341: periodontal scaling and root planing — four or more teeth per quadrant is a therapeutic procedure for patients with diagnosed periodontal disease, designed to remove cementum or dentin that is diseased or roughened by calculus, either as definitive treatment and/or pre-surgical care.

Claim submissions need to demonstrate documentation of bone and clinical attachment loss; pockets should be greater than 4mm. Where less than four teeth in a quadrant meet the criteria, the procedure may receive an alternate benefit of D4342: periodontal scaling and root planing — one to three teeth per quadrant. Scaling and root planing should not be billed at the same time as other non-surgical services and would be considered integral to periodontal surgery billed on the same date of service.

In the absence of any evidence of bone loss or attachment loss, the claim submission may receive an alternate benefit of D4346: scaling in the presence of generalized moderate or severe gingival inflammation-full mouth, after oral evaluation. This procedure is designed to manage moderate to severe gingival inflammation in the absence of diagnosed periodontitis and should not be reported in conjunction with prophylaxis, scaling and root planing, or debridement procedures. If the submission does not meet the criteria for either scaling and root planing nor a D4346, an alternate benefit of D1110: prophylaxis — adult may be applied instead.

Documentation should support the submission and needs to include:

1. Full mouth series of radiographs or periapical and bitewing X-rays of good diagnostic quality, which clearly show all teeth in the quadrant or quadrants being treated – in the past we asked that these be within 12 months; this is no longer a requirement.

___2. Periodontal charting that includes detail on probing depths and clinical attachment loss – we still ask that periodontal charting be within 12 months

If a submission was denied or received an alternate benefit and you wish to appeal, please include additional documentation supporting the appeal. This could include additional X-rays, photos, chart notes, and/or a narrative. Appeals must be received within 180 days of the denial and sent in writing via:

Email: AppealsAdmin@deltadentalva.com

or

Mail: Appeals Department

Delta Dental of Virginia

PO Box 12483

Roanoke, VA 24026

Michael Weitzner, DMD, MS

Dental Director, Delta Dental of Virginia

To prevent delays with your claims, please ensure you are using the most recent CDT codes. We encourage every dental practice to invest in a current CDT book to make sure you're submitting claims with current CDT codes. For the CDT e-book, mobile app, web app, or book, visit ADAstore.org or call 800.947.4746. Click below to download the new and revised CDT codes effective January 2024.

2024 marks the first year of Virginia operating its own state-based health insurance exchange known as the Virginia Insurance Marketplace (VIM). Delta Dental of Virginia has joined other insurance companies who offer a variety of plans and price points. Our new Essential Plan provides a low-cost option and limits coverage to the Delta Dental PPO™ network only. The Essential Plan provides no coverage for Delta Dental Premier^® and out-of-network dentists.  

If you are one of the more than 3,000 Virginia dentists in our Delta Dental PPO network, you have access to the Essential Plan patients. If you do not participate in our PPO network and are interested in joining, please contact your network representative here.

With more than 140,000 Virginians covered by Delta Dental Individual and Family™ plans today, network dentists are seeing more and more patients with individual coverage. A summary of all Delta Dental Individual and Family plans for Virginians is below:

Save the Date — Dental Coding Workshops

October

4

October

11

November

1

Registration details are coming this summer!

Delta Dental of Virginia continues to grow and put more patients in your chair!

Some of our new group clients are listed below. All of them have Delta Dental PPO™ and/or Delta Dental PPO Plus Premier™ plans.

• American Institutes for Research in the Behavioral Sciences (AIR)
• American Society of Clinical Oncology (ASCO)
• Client Solution Architects (CSA Global)
• Everfox (formerly Forcepoint Federal)
• Frederick County Public Schools
• City of Fredericksburg
• Iridium Satellite
• ITC Federal
• QinetiQ
• Schrader Bridgeport
• Seneca Holdings
• Thalhimer

Meet our Network Development Team

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