APPENDIX B Organization of HealthCare Example

Size: px
Start display at page:

Download "APPENDIX B Organization of HealthCare Example"

Transcription

1 10-1. emergency visits appropriate triage, treatment and follow-up Emergency Pt.: a. Triaged by Dr. with differential Diagnosis b. Radiograph taken by assistant c. Dr. confirms Diagnosis & does Treatment d. Appropriate FU scheduled if needed or pt scheduled for an initial visit.(appt. in 10 days and recall if missed) Quantitative (April and Oct) Comprehensive Examination as scheduled appointment a. Full mouth x-ray (FMX) bite wings or panograph is taken by assistant. FMX consists of periapical x-rays including bite wings. representati ve representati ve b. Prophylaxis or polishing of teeth & 80 Search Criteria: Emergency visit code: Search Criteria: Emergency visit April review (Sept 1, 2007 to Feb 28, 2008) Oct. review (March 1- Aug 31, 2008) code: D0140 & or D9110, 10 charts per dentist 10 charts per dentist Peer review 80 Code # D0150 and D1110 (new code combination for 2007) Comprehensive Exam and cleaning in last year

2 supra-gingival scaling is preformed by hygienist. c. Initial exam is preformed by doctor Quantitative (June) Initial exam requirements 1-5 Document #10-2 attached. Peer Review 10 charts per provider Initial Periodontal Therapy Initial Periodontal Therapy is scheduled with the hygienist and consist of: a. periodontal charting b. periodontal scaling / root planning c. re-evaluation d. follow-up based on severity of periodontal issues e. Appropriate referral if no resolution of pocket depth Quantitative (August) Initial Periodontal Therapy protocol attached (#10-3) expanded information for a-e Rep. 80 Peer Review 10 charts per hygienist code: D4342 & D charts per hygienist

3 10-6. Initial and Emergency visits chart reviews Qualitative (September) Protocol of exam attached (#10-6) Rep. 80 Peer review 10 charts per provider (Charts to encompass charts with dental codes D0120, or D0140, or D0150 ) Competence and evaluations are done yearly for dental staff members. Results are reported to HJA Board of Directors in May of each year. (7-9 HR) (May) Rep & HR Manager Report number completed 10- TX Completed within 1 year of Comprehensive visit. Oral Health Performance Measure: Percentage of dental patients seen for a comprehensive visit who completed their treatment plan within one year of the 70 charts randomly selected per calendar year reviewed. Universe: Pt with code D0150 Exclusions: pt. who transferred from CHC during the yr. after their comprehensive visit.

4 comprehensive visit Appropriate follow-up for selected high risk procedures such as: Extractions_-July Quantitative. Extraction (refer to Pt. National Safety Goals-(wrong site) ADA, recommendation ) Time Out Taken (T.O.T.) documented in medical record for all dental surgical procedures to insure the removal of the correct tooth/teeth. Extraction: 1. Consent obtained (Including risks, benefits, & alternatives.) 2. Results of procedure 3. Follow-up if indicated with pt. 4. Complications noted and appropriate follow- Dir. 100% TOT Peer review of all dentists

5 (July) up as needed. 5. Evidence of having marked x- ray or dental chart as to tooth to be extracted. 5. Time out documented

GOALS FOR THE PERIODONTAL PATIENT

GOALS FOR THE PERIODONTAL PATIENT 1 Goals for the Periodontal Patient: 1. Modify Risk Factors a. Overall goal is total health. b. Research shows that oral health is related to total health c. #1 preventable risk fact is tobacco use d.

More information

Michael Kanellis, DDS, MS ADEA BFACA Mid Year Meeting October 17, 2014

Michael Kanellis, DDS, MS ADEA BFACA Mid Year Meeting October 17, 2014 Michael Kanellis, DDS, MS ADEA BFACA Mid Year Meeting October 17, 2014 Michael Kanellis, DDS, MS ADEA BFACA Mid Year Meeting October 17, 2014 Implemented May 1, 2014 100,000+ low-income adults not eligible

More information

Introduction to Health Care & Careers. Chapter 20. Answers to Checkpoint and Review Questions

Introduction to Health Care & Careers. Chapter 20. Answers to Checkpoint and Review Questions Introduction to Health Care & Careers Chapter 20 Answers to Checkpoint and Review Questions Checkpoints 1. Name and briefly describe the nine dental specialties. The nine dental specialties are orthodontics

More information

Electronic Dental Records

Electronic Dental Records Electronic Dental Records Dr. Douglas K Benn, Professor of Maxillofacial Radiology & Director of Oral Diagnostic Systems, University of Florida and Health Conundrums LLC 8/2/2008 Dr Benn, University of

More information

PLANS FOR FAMILIES AND ADULTS Features & Benefit Details

PLANS FOR FAMILIES AND ADULTS Features & Benefit Details Page 1 of 7 s with comprehensive coverage s with basic coverage PLAN NETWORK Premier EPO EPO Altus Dental Participating Dentists Premier EPO EPO Altus Dental Participating Dentists **Premium child under

More information

PERIODONTAL CASE PRESENTATION - 1

PERIODONTAL CASE PRESENTATION - 1 PERIODONTAL CASE PRESENTATION - 1 Overview A 32 year-old patient presented with generalized aggressive periodontitis. Treatment included non-surgical therapy with adjunctive antibiotics and surgical treatment.

More information

PLAN OPTION 1 High Plan Out-of-Network Negotiated Fee - MAC

PLAN OPTION 1 High Plan Out-of-Network Negotiated Fee - MAC Pearl Companies Dental Metropolitan Life Insurance Company Network: PDP Coverage Type In-Network Schedule PLAN OPTION 1 High Plan Out-of-Network - MAC In-Network Schedule PLAN OPTION 2 Low Plan Out-of-Network

More information

The following chart provides an illustration of the dental coverage provided under the Plan. Summary of Dental Care Benefits

The following chart provides an illustration of the dental coverage provided under the Plan. Summary of Dental Care Benefits DENTAL CARE You or your eligible dependents may incur reasonable and customary charges for services and supplies provided by or under the supervision of a licensed, certified or registered oral surgeon

More information

What is a Dental HMO Plan?

What is a Dental HMO Plan? DENTAL INSURANCE What is a Dental HMO Plan? When you enroll in the Dental HMO (DHMO) plan, you will be assigned to a Primary Care Dentist (PCD) at the time of enrollment, unless you pre-select a PCD at

More information

Dentistry at Willow Mill Veterinary Hospital. Importance of Good Oral Hygiene. Steps for a Healthy Mouth

Dentistry at Willow Mill Veterinary Hospital. Importance of Good Oral Hygiene. Steps for a Healthy Mouth Willow Mill Veterinary Hospital 11 Willow Mill Park Road Mechanicsburg, PA 17050 www.willowmillvet.com Phone: (717)766-7981 Fax: (717) 766-6727 Email:willowmillvethosp@gmail.com Mon-Fri: 8AM-7PM, Sat:

More information

The Oral ATP- A Photo Tour

The Oral ATP- A Photo Tour The Oral ATP- A Photo Tour The Patient: Jax Goodman 1.5 year old, neutered male Labrador Retriever cross, 65 pounds Indication for oral examination: preventative therapy Stage 1: Assessment A. Initial

More information

Full Mouth Survey. Delta Dental of Massachusetts DeltaDentalMA.com

Full Mouth Survey. Delta Dental of Massachusetts DeltaDentalMA.com X-Rays Having X-rays taken is a painless procedure that uses small amounts of radiation to capture images of your teeth and bones. Because your dentist takes precautions and the amount of radiation used

More information

THE AMERICAN ACADEMY OF PERIODONTOLOGY

THE AMERICAN ACADEMY OF PERIODONTOLOGY THE AMERICAN ACADEMY OF PERIODONTOLOGY Suite 800 737 North Michigan Avenue Chicago, Illinois 60611-2690 www.perio.org 2005 The American Academy of Periodontology PDW PERIODONTAL DISEASES what you need

More information

BASS PRO, INC. / CABELA S

BASS PRO, INC. / CABELA S PPO BASE PLAN - Features BASS PRO, INC. / CABELA S BASE PLAN 2019 PPO Dentist Based on PPO reduced maximum plan allowance Premier Dentist Based on Premiermaximum plan allowance Non-Participating Dentist

More information

Employee Plan Information

Employee Plan Information Dental and Vision Premier Advantage FLEXIBLE DENTAL PLANS to meet your changing needs Employee Plan Information An option that allows you to move between the dental hmo and ppo plans as your needs change.

More information

Reimbursement Guide. ATRIDOX Insurance Reimbursement Guide for the submission of insurance claims

Reimbursement Guide. ATRIDOX Insurance Reimbursement Guide for the submission of insurance claims Reimbursement Guide Insurance Reimbursement Guide f the submission of insurance claims General reimbursement & submission infmation Reimbursement infmation Submission of insurance claims Pre-determination

More information

Clinpro Glycine Prophy Powder

Clinpro Glycine Prophy Powder Clinpro Glycine Prophy Powder 3M 2016. All Rights Reserved VIDEO 3M 2016. All Rights Reserved 2 Presentation Overview Air Polishing Procedure With Clinpro Glyciene Prophy Powder Use and Efficiency for

More information

MEDICAID REIMBURSEMENT

MEDICAID REIMBURSEMENT MEDICAID REIMBURSEMENT Medicaid for children under 20 Pays for exam, cleaning, and fluoride treatment every six months. $100 of x-rays per year. Pays for fillings, sealants, extractions, stainless steel

More information

MetLife Dental Insurance Plan Summary. In-Network % of Negotiated Fee * % of R&C Fee 100% 100% 80% 80% 50% 50%

MetLife Dental Insurance Plan Summary. In-Network % of Negotiated Fee * % of R&C Fee 100% 100% 80% 80% 50% 50% TriNet IV, Inc. Classic Option LA, MS, MT& TX Employees Network: PDP Plus Coverage Type Type A: Preventive (cleanings, exams, X-rays) Type B: Basic Restorative (fillings, extractions) Type C: Major Restorative

More information

Creighton University s Enhanced Dental Plan Benefits

Creighton University s Enhanced Dental Plan Benefits Creighton University s Enhanced Dental Plan Benefits For the savings you need, the flexibility you want and service you can trust. Benefit Summary Coverage Type PDP In-Network: Out-of-Network: Type A cleanings,

More information

Oral Health Standards of Care

Oral Health Standards of Care S OF CARE Oakland Transitional Grant Area Care and Treatment Services F EBRUARY 2007 Office of AIDS Administration 1000 Broadway, Suite 310 Oakland, CA 94607 Tel: (510) 268-7630 Fax: (510) 268-7631 AREAS

More information

PLANS FOR FAMILIES AND ADULTS 2018 Features & Benefit Details

PLANS FOR FAMILIES AND ADULTS 2018 Features & Benefit Details PLANS FOR FAMILIES AND ADULTS 2018 Features & Details Plans with Comprehensive Coverage PLAN NETWORK Participating Dentists EPO Participating Dentists EPO and EPO Is this a smaller network? No No Yes No

More information

MetLife Dental Insurance Plan Summary

MetLife Dental Insurance Plan Summary Public School Retirement System of the City of St Louis For MS and TX residents MetLife Dental Insurance Plan Summary Network: PDP Plus Coverage Type Type A: Preventive (cleanings, exams) Type B: Basic

More information

Services provided beyond a Member s benefit limit are not covered unless a BLE is requested and approved by Avesis.

Services provided beyond a Member s benefit limit are not covered unless a BLE is requested and approved by Avesis. April 1, 2012 Dear Provider: Avesis would like to thank you for your continued participation in the Avesis UPMC for You dental network. This notice is to inform you of some upcoming changes to benefits

More information

In-Network % of Negotiated Fee * % of Negotiated Fee * 100% 80% 50%

In-Network % of Negotiated Fee * % of Negotiated Fee * 100% 80% 50% Dental Metropolitan Life Insurance Company Network: PDP Plus Coverage Type Type A: Preventive (cleanings, exams, X-rays) Type B: Basic Restorative (fillings, extractions) Type C: Major Restorative (bridges,

More information

In-Network 100% 100% 50% 50% Deductible Individual $50 $50 Family $150 $150 Annual Maximum Benefit Per Person $1,250 $1,250

In-Network 100% 100% 50% 50% Deductible Individual $50 $50 Family $150 $150 Annual Maximum Benefit Per Person $1,250 $1,250 Douglas County School System Low Dental Plan Dental Metropolitan Life Insurance Company Network: PDP Plus Coverage Type Type A: Preventive (cleanings, exams, X-rays) Type B: Basic Restorative (fillings,

More information

DID YOU KNOW? Every in preventive oral care can save in restorative and emergency treatments. 1

DID YOU KNOW? Every in preventive oral care can save in restorative and emergency treatments. 1 DID YOU KNOW? Every in preventive oral care can save in restorative and emergency treatments. 1 Research shows that oral health and overall health are closely related. So when you keep your teeth healthy,

More information

The Checkup Clinic. Steve Stefanac. Associate Dean for Patient Services The University of Michigan School of Dentistry

The Checkup Clinic. Steve Stefanac. Associate Dean for Patient Services The University of Michigan School of Dentistry The Checkup Clinic Steve Stefanac Associate Dean for Patient Services The University of Michigan School of Dentistry Convergence of Issues New curriculum Early learners End of a student dental insurance

More information

For the savings you need, the flexibility you want and service you can trust.

For the savings you need, the flexibility you want and service you can trust. Cobb County School District Dental Plan Benefits For the savings you need, the flexibility you want and service you can trust. Benefit Summary Plan Option 1- Base Plan (Copay Plan) Coverage Type In-Network

More information

Dental Hygienists. Schedule of Dental Services and Fees for Ontario Works Adults Halton Oral Health Outreach Dental Care Counts

Dental Hygienists. Schedule of Dental Services and Fees for Ontario Works Adults Halton Oral Health Outreach Dental Care Counts Dental Hygienists Schedule of Dental Services and Fees for Ontario Works Adults Halton Oral Health Outreach Dental Care Counts 2017 TABLE OF CONTENTS This schedule provides fees for covered services for

More information

Effective Date: 6/1/2017. Replaces: 4/24/2012. Formulated: 10/85 Reviewed: 10/16 DENTAL TREATMENT LEVELS OF CARE

Effective Date: 6/1/2017. Replaces: 4/24/2012. Formulated: 10/85 Reviewed: 10/16 DENTAL TREATMENT LEVELS OF CARE CORRECTIONAL MANAGED HEALTH CARE POLICY MANUAL Effective Date: 6/1/2017 Replaces: 4/24/2012 Formulated: 10/85 Reviewed: 10/16 NUMBER: E-36.1 Page 1 of 1 DENTAL TREATMENT LEVELS OF CARE PURPOSE: To assure

More information

In-Network 100% 100% 80% 80% 50% 50%

In-Network 100% 100% 80% 80% 50% 50% Douglas County School System High Dental Plan Dental Metropolitan Life Insurance Company Network: PDP Plus Coverage Type Type A: Preventive (cleanings, exams, X-rays) Type B: Basic Restorative (fillings,

More information

Dental Benefits. When you use a MetLife PDP participating dentist:

Dental Benefits. When you use a MetLife PDP participating dentist: Dental Benefits As a benefits eligible team member, you have a choice of four dental plans: First Commonwealth/Guardian Dental Health Maintenance Organization (Dental HMO) MetLife Value Plan MetLife Preferred

More information

An Overview of Your Dental Benefits

An Overview of Your Dental Benefits An Overview of Your Dental Benefits Educators Health Alliance ii \ DENTAL BENEFITS PPO Dental Plan Options OPTION 1 Maintenance Dentistry OPTION 2 (STANDARD PLAN) IN-NETWORK OUT-OF-NETWORK 30% of allowable

More information

Surgical Care Affiliates Dental Plan Benefits

Surgical Care Affiliates Dental Plan Benefits Surgical Care Affiliates Dental Plan Benefits For the savings you need, the flexibility you want and service you can trust. Benefit PDP Plus Summary Core Plan All Full-Time and Part Time Teammates Buy

More information

PLAN OPTION 1. Network Select Plan. Out-of-Network % of R&C Fee **

PLAN OPTION 1. Network Select Plan. Out-of-Network % of R&C Fee ** Harvest Management Sub LLC. dba Holiday Retirement Dental Metropolitan Life Insurance Company Network: PDP Coverage Type Type A: Preventive (cleanings, exams, X-rays) Type B: Basic (fillings, extractions)

More information

Avesis Georgia Pregnant Women Covered Benefits and Fee Schedule

Avesis Georgia Pregnant Women Covered Benefits and Fee Schedule Dental services listed in this are to be performed by a General Dentist/Pediatric Dentist. services will be allowed to be performed by a dental specialist Endodontist, Oral Surgeon, Orthodontist, Guidelines

More information

Endodontics Root canal therapy Pulpotomy Apicoectomy Retrograde Filling. Oral Surgery Pallative Treatment

Endodontics Root canal therapy Pulpotomy Apicoectomy Retrograde Filling. Oral Surgery Pallative Treatment Washoe County School District Dental Benefit Matrix $2,000 Calendar Year Max; $50 Deductible, $100 Family Deductible Unlimited Maximum for Dependent Children to age 19; No Orthodontic Coverage Standard

More information

DENTAL PLAN QUICK FACTS AND QUICK LINKS

DENTAL PLAN QUICK FACTS AND QUICK LINKS DENTAL PLAN QUICK FACTS AND QUICK LINKS A Quick Look at the Dental Plan Dental Service TakeCare Network Dentists Only Annual Maximum Benefit $1,500 per covered person per calendar year Diagnostic & Preventive

More information

PLAN OPTION 1 Basic Plan. Out-of-Network % of R&C Fee ** % of Negotiated. Deductible Individual $35 $35 $50 $50

PLAN OPTION 1 Basic Plan. Out-of-Network % of R&C Fee ** % of Negotiated. Deductible Individual $35 $35 $50 $50 Dental Metropolitan Life Insurance Company Network: PDP Plus Coverage Type Type A: Preventive (cleanings, exams, X-rays) Type B: Basic (fillings, extractions) Type C: Major (bridges, dentures) Type D:

More information

PLAN OPTION 1 Low Plan Employees (30 hours) Out-of-Network % of Negotiated Fee*

PLAN OPTION 1 Low Plan Employees (30 hours) Out-of-Network % of Negotiated Fee* Green Dot Public Schools MetLife Dental Insurance Plan Summary Network: PDP PLAN OPTION 1 Low Plan Employees (30 hours) PLAN OPTION 2 High Plan Employees (30 hours) Coverage Type In-Network Fee * Out-of-Network

More information

Georgia State University Dental Plan Benefits

Georgia State University Dental Plan Benefits Georgia State University Dental Plan Benefits For the savings you need, the flexibility you want and service you can trust. Benefit Summary Coverage Type PDP In-Network Out-of-Network Type A cleanings,

More information

PLEASE READ THE FOLLOWING INFORMATION CAREFULLY FOR YOUR PROCEDURE FREQUENCIES AND PROVISIONS.

PLEASE READ THE FOLLOWING INFORMATION CAREFULLY FOR YOUR PROCEDURE FREQUENCIES AND PROVISIONS. PLEASE READ THE FOLLOWING INFORMATION CAREFULLY FOR YOUR PROCEDURE FREQUENCIES AND PROVISIONS. All dental benefits are paid according to the terms of the Master Contract between the Health Plan and PBM

More information

Blue Edge Dental SCHEDULE OF BENEFITS, EXCLUSIONS AND LIMITATIONS - HIGH

Blue Edge Dental SCHEDULE OF BENEFITS, EXCLUSIONS AND LIMITATIONS - HIGH Blue Edge Dental A. BENEFITS SCHEDULE OF BENEFITS, EXCLUSIONS AND LIMITATIONS - HIGH Annual Deductible Per Insured Person $50 Per Calendar Year Annual Maximum Per Insured Person $1,000 Covered Services:

More information

Paychex Dental Plan Benefits - Met Life Your Choice PPO

Paychex Dental Plan Benefits - Met Life Your Choice PPO Paychex Dental Plan Benefits - Met Life Your Choice PPO Network: PDP Plus Benefit Summary Coverage Type In-Network Out-of-Network Type A cleanings, oral examinations 100% of Negotiated Fee* 100% of Negotiated

More information

Educational Service Center of Cuyahoga County Dental Plan Benefits

Educational Service Center of Cuyahoga County Dental Plan Benefits Educational Service Center of Cuyahoga County Dental Plan Benefits Network: PDP Plus Benefit Summary Coverage Type In-Network Out-of-Network Type A cleanings, oral examinations 100% of Negotiated Fee*

More information

Symantec Corporation Plan 1.0 Dental Plan Benefits

Symantec Corporation Plan 1.0 Dental Plan Benefits Symantec Corporation Plan 1.0 Dental Plan Benefits Network: PDP Benefit Summary Coverage Type In-Network Out-of-Network Type A cleanings, oral examinations 100% of Negotiated Fee* 100% of R&C Fee** Type

More information

Dental. Lower Colorado River Authority. Network: PDP Plus. L i s t o f P r i m a r y C o v e r e d S e r v i c e s & L i m i t a t i o n s.

Dental. Lower Colorado River Authority. Network: PDP Plus. L i s t o f P r i m a r y C o v e r e d S e r v i c e s & L i m i t a t i o n s. Lower Colorado River Authority Dental Metropolitan Life Insurance Company Network: PDP Plus Coverage Type Type A: Preventive (cleanings, exams, X-rays) Type B: Basic Restorative (fillings, extractions)

More information

Dental Supplement. Hygienist. Ministry of Social Development and Poverty Reduction

Dental Supplement. Hygienist. Ministry of Social Development and Poverty Reduction Dental Supplement Hygienist Ministry of Social Development and Poverty Reduction TABLE OF CONTENTS Part A - Preamble - Dental Supplements - Hygienist pages i - iii The Preamble - Dental Supplements - Hygienist

More information

Dental. Ingredion Corporation. Network: PDP. In-Network. Out-of-Network. Coverage Type. Metropolitan Life Insurance Company

Dental. Ingredion Corporation. Network: PDP. In-Network. Out-of-Network. Coverage Type. Metropolitan Life Insurance Company Ingredion Corporation Dental Metropolitan Life Insurance Company Network: PDP Coverage Type Type A: Preventive (cleanings, exams, X-rays) Type B: Basic Restorative (fillings, extractions) Type C: Major

More information

Health Options Program

Health Options Program Pennsylvania Public School Employees Retirement System (PSERS) Health Options Program The MetLife Dental Plan You and your spouse, if he or she is Medicare-eligible, can enroll in the MetLife Dental Plan

More information

MetLife Dental Insurance Plan Summary

MetLife Dental Insurance Plan Summary Northshore School District MetLife Dental Insurance Plan Summary Network: PDP Plus Coverage Type Level 1 % of Negotiated 99% of R&C * % of Negotiated Level 2 99% of R&C * Type A: Preventive (cleanings,

More information

New Haven/Fairfield Counties Ryan White Part A Program Oral Health Standard of Care

New Haven/Fairfield Counties Ryan White Part A Program Oral Health Standard of Care DENTAL/ORAL HEALTH I. DEFINITION OF SERVICE Support for Oral Health Services including diagnostic, preventive, and therapeutic dental care that is in compliance with state dental practice laws, includes

More information

Dental. EAG, Inc. - All locations except Easton & Columbia. Network: PDP Plus. In-Network. Out-of-Network. Coverage Type

Dental. EAG, Inc. - All locations except Easton & Columbia. Network: PDP Plus. In-Network. Out-of-Network. Coverage Type EAG, Inc. - All locations except Easton & Columbia Dental Network: PDP Plus Coverage Type Type A: Preventive (cleanings, exams, X-rays) In-Network Out-of-Network % of Negotiated Fee * % of R&C Fee ** 100%

More information

Dental plan premiums. Plan name Age 60+ These premiums apply to members who live anywhere in Alaska.

Dental plan premiums. Plan name Age 60+ These premiums apply to members who live anywhere in Alaska. Dental plan premiums These premiums apply to members who live anywhere in Alaska. Plan name Age 60+ Premier $46 PPO SM 1000 $43 PPO SM 1500 $50 Premier Preventive Alaska Mandated Plan $30 Premiums effective

More information

Dentistry at Trenant Park Pet Clinic

Dentistry at Trenant Park Pet Clinic Dentistry at Trenant Park Pet Clinic Like humans, pet dental care is an important part of a healthy lifestyle. Without proper dental care, our pets can suffer from pain and discomfort, poor appetite, and

More information

Complainant v. the College of Dental Surgeons of British Columbia

Complainant v. the College of Dental Surgeons of British Columbia Health Professions Review Board Suite 900, 747 Fort Street, Victoria, BC V8W 3E9 Complainant v. the College of Dental Surgeons of British Columbia DECISION NO. 2015-HPA-221(a) September 13, 2016 In the

More information

PERIODONTAL (GUM) DISEASE & IT S TREATMENT

PERIODONTAL (GUM) DISEASE & IT S TREATMENT PERIODONTL (GUM) DISESE & IT S TRETMENT What do healthy gums look like? In a healthy mouth, gums are pink and do not bleed on tooth brushing. They are firm and cannot be easily separated from teeth. What

More information

MetLife Dental Insurance Plan Summary

MetLife Dental Insurance Plan Summary MetLife Dental Insurance Plan Summary Network: PDP Plus Coverage Type Type A: Preventive (cleanings, exams, X-rays) Type B: Basic (fillings, extractions) Type C: Major (bridges, dentures) In-Network %

More information

Articles: Frequently Asked Questions About Common Dental Terms. Table of Contents

Articles: Frequently Asked Questions About Common Dental Terms. Table of Contents Articles: Frequently Asked Questions About Common Dental Terms Table of Contents Frequently Asked Questions About Radiographs (X-rays).1 Frequently Asked Questions About Preventive Care for Members.3 Frequently

More information

Periodontal Maintenance

Periodontal Maintenance Periodontal Maintenance Friday, February 20, 2015 1:06 PM Periodontal disease control always begins with patient education - Plaque control, diet, smoking cessation, impact that systemic health has on

More information

PLAN OPTION 1 High Plan. Out-of-Network % of R&C Fee ** % of Negotiated 100% 100% 100% 100% 80% 80% 50% 50%

PLAN OPTION 1 High Plan. Out-of-Network % of R&C Fee ** % of Negotiated 100% 100% 100% 100% 80% 80% 50% 50% Covenant Health All Full Time and Part Time Employees Excluding Maristhill Union Employees Dental Network: PDP Plus Coverage Type Type A: Preventive (cleanings, exams, X-rays) Type B: Basic (fillings,

More information

SECTION XVI. EssentialSmile Ped 111, ST, INN, Pediatric Dental SCHEDULE OF BENEFITS

SECTION XVI. EssentialSmile Ped 111, ST, INN, Pediatric Dental SCHEDULE OF BENEFITS SECTION XVI. EssentialSmile Ped 111, ST, INN, Pediatric Dental SCHEDULE OF BENEFITS COST-SHARING PEDIATRIC DENTAL CARE ESSENTIAL HEALTH BENEFIT Deductible One (1) Member under age 19 Two (2) or more Members

More information

PLAN OPTION 1 High Plan. Out-of-Network % of R&C Fee ** % of Negotiated

PLAN OPTION 1 High Plan. Out-of-Network % of R&C Fee ** % of Negotiated Clearway Energy Group LLC Dental Metropolitan Life Insurance Company Network: PDP Plus Coverage Type In-Network % of Negotiated Fee * PLAN OPTION 1 High Plan In-Network Out-of-Network % of R&C Fee ** %

More information

Dental POS Benefit Summary

Dental POS Benefit Summary Policyholder: UC Postdoctoral Scholar Dental POS Benefit Summary Effective date: 01/01/2019 This chart provides you a brief summary of the key benefits of the dental coverage available from Principal Life

More information

III. Dental Program Table of Contents

III. Dental Program Table of Contents III. Dental Program Table of Contents About This Section...1 An Overview of Your Dental Program Options...2 Delta Dental...3 Preventive/Diagnostic Care...3 Basic Restorative Care...3 Major Restorative

More information

Blue Edge Dental SCHEDULE OF BENEFITS, EXCLUSIONS AND LIMITATIONS - HIGH A. BENEFITS

Blue Edge Dental SCHEDULE OF BENEFITS, EXCLUSIONS AND LIMITATIONS - HIGH A. BENEFITS Blue Edge Dental SCHEDULE OF BENEFITS, EXCLUSIONS AND LIMITATIONS - HIGH A. BENEFITS Annual Deductible Per Insured Person Annual Deductible Per Insured Family $100 Per Calendar Year $300 Per Calendar Year

More information

It's Time to Enroll for Benefits

It's Time to Enroll for Benefits Dental Insurance It's Time to Enroll for Benefits MetLife Dental for State of Oklahoma employees Dental Insurance Group Benefits Dental options for State of Oklahoma employees MetLife Dental Plans always

More information

In-Network 100% 80% 50%

In-Network 100% 80% 50% National Louis University PPO Dental Plan High Dental Network: PDP Plus Coverage Type In-Network Out-of-Network % of Negotiated Fee * % of R&C Fee ** Type A: Preventive (cleanings, exams, X-rays) Type

More information

Uniform Dental Benefits: State Participants 2015

Uniform Dental Benefits: State Participants 2015 Uniform Dental Benefits (Certificate of Coverage) Please read the following information carefully for Your procedure frequencies and provisions. All dental benefits are paid according to the terms of the

More information

The following are things to look for when seeing patients in our practice:

The following are things to look for when seeing patients in our practice: DO MORE PERIO, HELP YOUR PATIENTS, HELP YOUR PRACTICE. MARTY NAGER, DMD, FICD DIPLOMATE, AMERICAN BOARD OF PERIODONTOLOGY 67 JEFFERSON BOULEVARD WARWICK, RI 02888 401-781-2742 @cox..martynager. THE PERIODONTALLY-ORIENTED

More information

Uniform Dental Benefits Certificate of Coverage

Uniform Dental Benefits Certificate of Coverage PLEASE READ THE FOLLOWING INFORMATION CAREFULLY FOR YOUR PROCEDURE FREQUENCIES AND PROVISIONS. All dental benefits are paid according to the terms of the Master Contract between the Health Plan and PBM

More information

Dental POS Benefit Summary

Dental POS Benefit Summary Dental POS Benefit Summary PFG HC Dental 13 Predetermination of Benefits: Before treatment begins for inlays, onlays, single crowns, prosthetics, periodontics and oral surgery, you may file a dental treatment

More information

Auditing in periodontal treatment and disease.

Auditing in periodontal treatment and disease. .. Auditing in periodontal treatment and disease. Background. Undiagnosed and untreated periodontal disease is one of the fastest growing areas of litigation and complaints in dentistry. People are living

More information

PERIODONTAL. Periodontal Disease. Don t wait until it hurts SAMPLE

PERIODONTAL. Periodontal Disease. Don t wait until it hurts SAMPLE PERIODONTAL Periodontal Disease Don t wait until it hurts Periodontal disease is also known as gum disease Periodontal (perry-o-don-tal) Disease is an infection and inflammation that affects the tissues

More information

City Electric Supply Dental Plan Benefits

City Electric Supply Dental Plan Benefits City Electric Supply Dental Plan Benefits Network: PDP Plus Benefit Summary Coverage Type In-Network Out-of-Network Type A cleanings, oral examinations 100% of Negotiated Fee* 100% of R&C Fee** Type B

More information

MetLife Dental Insurance Plan Summary

MetLife Dental Insurance Plan Summary University of Louisiana at Lafayette MetLife Dental Insurance Plan Summary Network: PDP Plus Coverage Type In-Network Out-of-Network % of Negotiated Fee * 90% of R&C Fee ** Type A: Preventive (cleanings,

More information

SECTION 8 DENTAL BENEFITS SCHEDULE OF DENTAL BENEFITS

SECTION 8 DENTAL BENEFITS SCHEDULE OF DENTAL BENEFITS SECTION 8 DENTAL BENEFITS The Fund pays up to a maximum of $2,000 per year for Dental expenses incurred by Participants and/or Dependents age 19 or over in accordance with the Schedule of Dental benefits;

More information

Dental plan premiums for Oregon

Dental plan premiums for Oregon Dental plan premiums for Oregon These premiums apply to members who live anywhere in Oregon. Plan name *Age 60+ PPO SM $40 Exclusive PPO SM $44 Premiums effective Jan. 1, 2018, through Dec. 31, 2018 *

More information

PART 3 WHAT IS COVERED

PART 3 WHAT IS COVERED PART 3 WHAT IS COVERED A. DEDUCTIBLE Deductible is the amount of charges you will pay before We begin to pay for certain Covered Services. 1. Your Yearly Deductible for Covered Services is $25.00. During

More information

In-Network 100% 80% 50%

In-Network 100% 80% 50% Central Piedmont Community College Dental Metropolitan Life Insurance Company Network: PDP Plus Coverage Type Type A: Preventive (cleanings, exams, X-rays) Type B: Basic Restorative (fillings, extractions)

More information

SECTION XVI. EssentialSmile Ped 111, ST, INN, Pediatric Dental Schedule of Benefits

SECTION XVI. EssentialSmile Ped 111, ST, INN, Pediatric Dental Schedule of Benefits COST-SHARING SECTION XVI. EssentialSmile Ped 111, ST, INN, Pediatric Dental Schedule of Benefits Members can search for a Network Provider at www.solsticecare.com/provider-search.aspx Member Services:

More information

2017 Oregon Dental Conference Course Handout

2017 Oregon Dental Conference Course Handout 2017 Oregon Dental Conference Course Handout Kimberly Miller, RDH Course 8123: Principle Based Periodontal Therapy and Treatment Planning! Thursday, April 6 9 am - 4:30 pm Principle Based Periodontal Therapy

More information

Periodontal. Disease. Don t wait until it hurts. ADA Healthy Smile Tips

Periodontal. Disease. Don t wait until it hurts. ADA Healthy Smile Tips This brochure covers: the causes of gum disease the stages of gum disease how gum disease is diagnosed and treated how to keep your mouth healthy after treatment PERIODONTAL Periodontal ADA Healthy Smile

More information

HIGH OPTION PLAN for Eligible Part and Full-Time Employees Excluding Employees Residing in Mississippi or Texas. Out-of-Network.

HIGH OPTION PLAN for Eligible Part and Full-Time Employees Excluding Employees Residing in Mississippi or Texas. Out-of-Network. Dental Insurance Plan Summary Excluding Employees Residing in Mississippi or Texas Network: PDP Plus HIGH OPTION PLAN for Eligible Part and Full-Time Employees Excluding Employees Residing in Mississippi

More information

Shared Learning: Oral Health. Special Guest: Glenn Puckett, Director of Health Systems Integration with Washington Dental Service Foundation

Shared Learning: Oral Health. Special Guest: Glenn Puckett, Director of Health Systems Integration with Washington Dental Service Foundation Shared Learning: Oral Health Special Guest: Glenn Puckett, Director of Health Systems Integration with Washington Dental Service Foundation SHARED LEARNINGS FUNDED BY THE ANTHEM FOUNDATION 55 Putting the

More information

Plan Details and Rates. Monthly Premium Rate Schedule

Plan Details and Rates. Monthly Premium Rate Schedule Basis of Reimbursement Plan Details and Rates MetLife Option 1 (Low) MetLife Option 2 (High) In-Network Out-of-Network In-Network Out-of-Network 70th percentile 70th percentile of Negotiated Negotiated

More information

In-Network 70% Deductible Individual $25 $50 Annual Maximum Benefit Per Person $2,000 $2,000

In-Network 70% Deductible Individual $25 $50 Annual Maximum Benefit Per Person $2,000 $2,000 UC Berkeley Student Health Insurance Plan (SHIP) Group Number: 151675 MetLife Dental Insurance Plan Summary Network: PDP Plus Coverage Type Type A: Preventive (cleanings, exams, X-rays) Type B: Basic Restorative

More information

Colorado Summit. Updates for Providers in the Colorado Medicaid Dental Program. This issue of the Colorado Summit will cover the following:

Colorado Summit. Updates for Providers in the Colorado Medicaid Dental Program. This issue of the Colorado Summit will cover the following: Colorado Summit Updates for Providers in the Colorado Medicaid Dental Program Vol. 6 October 2015 This issue of the Colorado Summit will cover the following: Provider Revalidation Dental Hygiene Providers

More information

INTRODUCTION TO GUARDIAN CLINICAL POLICY

INTRODUCTION TO GUARDIAN CLINICAL POLICY DENTAL INSURANCE INTRODUCTION TO GUARDIAN CLINICAL POLICY April 26, 2018 Introduction and General Clinical Guidelines Prosthodontics Periodontics Oral Surgery General Anesthesia/IV Sedation Page 1 of 6

More information

CODA Guidelines for Dental Therapy Education: Implications for Expansion of Dental Therapy in the U.S.

CODA Guidelines for Dental Therapy Education: Implications for Expansion of Dental Therapy in the U.S. CODA Guidelines for Dental Therapy Education: Implications for Expansion of Dental Therapy in the U.S. Jane Koppelman, Research Director, Pew Dental Campaign Wisconsin Oral Health Conference September

More information

Anthem Blue Dental PPO Voluntary Option 2V Summary of Benefits

Anthem Blue Dental PPO Voluntary Option 2V Summary of Benefits Anthem Blue Dental PPO Voluntary Option 2V Summary of Benefits Annual Benefit Limit: $1500 Annual Member Deductible: $50 PPO Dentist $50 Non-PPO Dentist Family Coverage Deductible Limit 3 times Annual

More information

Dental EPO Benefit Summary

Dental EPO Benefit Summary Dental EPO Benefit Summary PFG HC Dental 12 Predetermination of Benefits: Before treatment begins for inlays, onlays, single crowns, prosthetics, periodontics and oral surgery, you may file a dental treatment

More information

School District of Collier County Dental Plan Review

School District of Collier County Dental Plan Review School District of Collier County Dental Plan Review Dental Plan Effective: January 1, 2013 Making your plan election Things to Consider: Cost of premium compared to cost of dental services consider the

More information

D0145 Oral evaluation for a patient under three years of age and counseling with primary caregiver

D0145 Oral evaluation for a patient under three years of age and counseling with primary caregiver Glossing Over Potential Possibilities for Coding and Income Potential Potential opportunities to bring in income can be ignored when billable services are not submitted for reimbursement. Overutilization

More information

Welcome to Arkansas Blue Cross and Blue Shield Dental Plan

Welcome to Arkansas Blue Cross and Blue Shield Dental Plan Welcome to Arkansas Blue Cross and Blue Shield Dental Plan University of Arkansas System Dental Program Beginning January 1, 2018, the University of Arkansas System dental plan will be administered by

More information

A Reason to Smile. Dental Care with No Surprises. Dental insurance underwritten by: Mutual of Omaha Insurance Company

A Reason to Smile. Dental Care with No Surprises. Dental insurance underwritten by: Mutual of Omaha Insurance Company A Reason to Smile Dental Care with No Surprises Dental insurance underwritten by: Mutual of Omaha Insurance Company 258665 Knowing what a visit to the dentist will cost is challenging. And dental coverage

More information

Houston County Board of Education Dental Plan Benefits

Houston County Board of Education Dental Plan Benefits Houston County Board of Education Dental Plan Benefits For the savings you need, the flexibility you want and service you can trust. Network: PDP Plus Benefit Summary Plan Option 1 Low Plan Plan Option

More information

Behind every beautiful smile should be a healthy mouth. C3 Coast Comprehensive Care

Behind every beautiful smile should be a healthy mouth. C3 Coast Comprehensive Care Behind every beautiful smile should be a healthy mouth C3 Coast Comprehensive Care The Coast Dental Commitment Creating beautiful and healthy smiles, one patient at a time When it comes to comprehensive

More information