Oregon  |  Winter 2018
2018 CDT changes and processing policy updates
On Jan. 1, 2018, Delta Dental of Oregon (DDOR) will implement the new codes that the ADA has outlined in CDT-18. The chart below shows how the DDOR standard contract will cover these CDT-18 codes.

Please go to Benefit Tracker for specific benefit information and group limitations of each patient's plan. Some plans may handle the codes differently than the DDOR standard contract.

Additionally, codes D5510, D5610 and D5620 will be deleted with CDT-18. DDOR will no longer accept these deleted codes after March 2018.

CDT-2018 code books can be purchased through the American Dental Association at ada.org

New CDT codes covered under DDOR Standard Commercial plans. No other new codes will be covered by Standard plans.

Code
Description
Comments
D5511
Repair broken complete denture base, mandibular

Fees for repairs of complete dentures, if
performed within six months of initial placement by the same dentist/dental office are disallowed.
D5512
Repair broken complete denture base, maxillary
Fees for repairs of complete dentures, if
performed within six months of initial placement by the same dentist/dental office are disallowed.
D5611
Repair resin partial denture base, mandibular

Fees for repairs of resin partial dentures, if performed within six months of initial placement by the same dentist/dental office are disallowed.
D5612
Repair resin partial denture base, maxillary

Fees for repairs of resin partial dentures, if performed within six months of initial placement by the same dentist/dental office are disallowed.
D5621
Repair cast partial framework,
mandibular

Fees for repairs of cast partial dentures, if performed within six months of initial placement by the same dentist/dental office are disallowed.
D5622
Repair cast partial framework,
maxillary

Fees for repairs of cast partial dentures, if performed within six months of initial placement by the same dentist/dental office are disallowed.
D9222
Deep sedation/general anesthesia - first 15 minutes
a. Deep sedation/general anesthesia
is a benefit only when administered;
(1) with appropriate monitoring by a properly licensed provider who is acting in compliance with applicable State rules and regulations, and
(2) in conjunction with oral surgical
procedures (D7000-D7999) when covered, or when necessary due to concurrent medical conditions. Otherwise, the benefit for deep
sedation/general anesthesia is DENIED.
D9239
Intravenous moderate (conscious)
sedation/analgesia - first 15 minutes

a. Intravenous moderate (conscious) sedation/analgesia is a benefit only when administered;
(1) in a dental office with appropriate monitoring by an appropriately licensed and qualified dentist who is acting in compliance with applicable rules and regulations, and
(2) in conjunction with oral surgical procedures (D7000-D7999) when covered, or when necessary due to concurrent medical conditions.
Otherwise, the benefit for intravenous moderate (conscious) sedation/analgesia is DENIED.

Questions?
Please contact the Delta Dental of Oregon Dental Customer Service department toll-free at 877-277-7280 or email us at dental@modahealth.com.
adidas America, Inc. partners with Delta Dental of Oregon

We're excited to let you know starting Jan. 1, 2018, adidas America, Inc. will be administered by Delta
Dental of Oregon. adidas was previously administered by Delta Dental of Massachusetts. adidas members will continue to enjoy the same great benefits with the addition of the Health through Oral Wellness program. 

This program uses a clinical oral health assessment to help determine which patients have greater risk for oral diseases. Those at higher risk are eligible for extra benefits to help them achieve better oral health.

Become a registered provider
A service representative is available to discuss the value of your participation in this program. They can
guide you through the risk assessment process. To learn more, call our dental professional relations
team at 844-663-4433 or visit deltadentalor.com/oralwellness/providers.

For questions about your adidas dental benefits, please call our dental customer service team at 844-663-4440.
Nike plan updates

On Jan. 1, 2018, the Basic and Plus plans are changing from Premier plans to PPO plans. However, Premier-only dentists will not be considered out of network.

> Basic plan- $300 annual maximum, 100% Class I, no coverage for Class II or III services
> Plus plan- $1,500 annual maximum, 100% Class I, 80% Class II, 60% Class III, $25 deductible waived on Class I. Ortho- 50% up to $1750 lifetime maximum, no deductible.

Plus plan only changes:
> Posterior composites are now covered.
> Preventive services (Class I) will not count towards the annual maximum of $1,500.

Please note: ID cards will be issued only if there is a dependent or plan change. Prior ID cards will still carry the Premier Network language. However, the member ID and group number will remain the same.

If you have any questions, please call our dental customer service team at 800-964-4637.
Intel moving to risk-based benefit

Intel Corporation is implementing a risk-based approach to dental care. Starting Jan. 1, 2018, its Delta
Dental PPO plan (group #05178, administered by Delta Dental of California) will cover one exam per
calendar year for adults at low risk for oral health problems.

Two exams per calendar year will be covered for children to age 14 and high-risk adults, including those who have had restorative, endodontic or periodontal treatment within the last three years. If Delta Dental of California receives a claim for a second annual exam, they will check the patient's treatment
history to determine risk level and apply the appropriate benefit.

Intel patients will continue to be covered for two annual cleanings or up to four cleanings for patients with certain periodontal or chronic conditions.

Questions?
For questions, please call Delta Dental of California's customer service team at 888-335-8227.
Provider Handbooks
 

503-265-5720 | dpr@modahealth.com | modahealth.com
601 S.W. Second Avenue
Portland, OR 97204