Delta Dental of Colorado has recently made some updates to the processing policies for orthodontic codes. The age limitations on the orthodontic treatment codes have been removed and will now be processed according to the ADA's CDT descriptors of dentition. If you have concerns that claims you submitted for dates of treatment starting after 1/1/16 were incorrectly processed because of age limitations, please contact our customer relations department by calling 1-800-610-0201 or emailing customer_service@ddpco.com to have those claims reprocessed. We appreciate your help in this matter.

At the beginning of 2016, we alerted you to a change in our processing policy around D4341. Because of some system issues, it has taken us longer than expected to implement this new policy. We will now be enforcing the policy of only benefitting two quads of D4341 per date of service. This policy has been put in place for a number of reasons, including safety, fraud and abuse, and appropriate treatment.  We understand that there are a number of exceptions to this rule and will review these instances on a case-by-case basis through the appeals process. If you appeal this processing policy, please note that you will be asked to provide us with the following items:

• Recent perio chart (within six months).
• Rationale for treating all four quads in one appointment.
• Narrative/chart notes.
• Full-mouth or pano X-rays.
• Image showing appointment timeframe (e.g., screen print of computer appointment or copy of page in appointment book). 

Two ADA codes have been added to the RDH fee schedule, effective June 1, 2016.  D0145: oral evaluation for a patient under three years of age and counseling with primary caregiver is a benefit 2 times per 12-month period. This code does apply to frequency limitations for all other exams. The D0277: vertical bitewings - 7-8 radiographs is a benefit once every 12 months and does count towards the radiograph frequency limits. Please remember that all benefits are subject to group-specific limitations and exclusions, so please verify benefits for all patients before beginning treatment.  

We realize that there are some very specific limitations and exclusions in the CHP+ program and would like to share those with you. These can also be found by the member in their benefit booklets. This plan offers benefits for the following and are subject to specific procedures and limitations:

• Diagnostic services (annual exam and X-rays)
• Preventive services (annual cleaning, fluoride, and sealants)
• Basic restorative services (fillings and stainless steel crowns) - resin restorations on posterior teeth are not a benefit. However, an alternate benefit up to the dentist's allowable fee for an amalgam restoration will be allowed. The patient/parent will be responsible to pay any cost difference between the dentist's amalgam filling fee and resin filling fee in addition to the required coinsurance for the amalgam procedure. 
• Oral surgery services (extractions)
• Endodontic services (root canal)
• Third molar extractions: Complete a pre-treatment estimate form for a third molar extraction to determine if it is covered. Prophylactic removal of third molars is not a covered benefit. Removal because of malocclusion or orthodontic reasons is not covered. The removal of third molars for active caries that renders the tooth unrestorable and/or involves the pulp may be covered with prior approval. Third molar removal may be covered with prior written approval for active periodontal infections that cannot be treated in another manner. Third molars fully impacted in bone are not covered for removal. Partial bony impactions and soft tissue impactions may be covered with prior approval if the tooth and/or supporting structures are involved with active disease such as an acute periodontal infection. Second opinions may be required as part of the approval process prior to treatment. If emergency removal of a third molar is needed, radiographs and/or documentation of the pathological condition causing the emergent situation may be required prior to payment.