Claims requirements

For providers

Fast-track your claims

When you submit claims for certain procedures, include all required documentation so your claims can be processed promptly and accurately.

General submission requirements

Be sure you follow these basics when you submit claims:

If radiographs are required, you can submit copies (paper or digital) of images, as long as they're of diagnostic quality.
Avoid mailing original radiographic images if they're your only copies (unless you include a stamped, self-addressed envelope so we can return them).
When you submit chart notes, always include the diagnosis and justification for all treatment.
Enter chart notes and narratives in the Remarks or Comments field of the claim, and maintain narratives as part of the patient treatment record.
When determining cracked teeth, build-ups, crowns and anterior restorations, if evidence of necessity isn't obvious in the radiographs, include photographs as well.

Documentation required for select procedures

For certain procedure codes, when you submit a claim you must include specific documentation or the claim will be automatically denied for lack of documentation.

Review the procedures that require documentation and be sure you meet all requirements when you submit a claim. For procedures not listed here, don't submit additional documentation (unless Dentegra requests it).

Procedure codes	Description of service	Documentation requirements
D2710 – D2794	Crowns	Periapical radiograph – pre-operative Photographs – any available
D2950 – D2957	Core buildup, including any pins	Periapical radiograph Photographs – any available Narrative
D2980 – D2983 D5621 – D5622	Repair requiring lab work	Narrative Copy of lab bill
D3310 – D3330 D3921	Endodontics	Periapical radiographs – pre- and post-operative
D4210 – D4212 D4240 – D4245 D4260 – D4285 D4341 – D4342 D4381	Periodontics (including scaling and root planing)	Bitewing radiographs Periodontal charting Chart notes including periodontal case type and diagnosis
D4249	Crown lengthening	Bitewing radiographs – pre-treatment Clinical narrative
D4322 – D4323	Provisional splinting	Narrative including necessity of treatment and mobility of teeth Periapical or bitewing radiographs documenting bone loss
D4920	Unscheduled dressing change	Narrative including necessity of treatment
D6055 – D6077 D6082 – D6088 D6094 D6097 – D6099 D6110 – D6123 D6194 – D6195	Implant supported prosthetics	Periapical radiographs — current Photographs — any available
D6710 – D6794	Prosthodontics, fixed (bridge abutment crowns)	Periapical radiograph — pre-operative Photographs — any available
D7210 – D7241 D7251	Oral surgery (impacted tooth)	Periapical or panoramic radiographs — current Chart notes, detailed tooth specific Photographs — any available
D7260 D7530 D7540	Oral surgery	Narrative including necessity of treatment
D7285 – D7286	Oral surgery (biopsy)	Pathology report copy
D7410 – D7415 D7440 – D7461 D7465	Oral surgery (excision of lesion)	Pathology report copy Chart notes, detailed operative
D7260 D7490 – D7521 D7530 D7540 D7610 – D7780 D7910 – D7912 D7980 – D7983 D7998	Oral surgery (surgical incision/excision)	Chart notes, detailed operative
D8010 – D8090	Orthodontics	Narrative including diagnosis, orthodontia type and treatment length
D8210 D8680	Orthodontics	Narrative including necessity of treatment
D9930 D##99	Miscellaneous services	Narrative for any exceptional cases and/or unspecified codes in all categories of service (D##99)

Notes

Pre-treatment radiographs, photographs and charting should be taken within 12 months of the planned treatment unless otherwise specified.

Dentegra reserves the right to request radiographic images and documentation during our clinical review of claims and pre-treatment estimates, even if the procedure is not listed here.

An itemized Explanation of Benefits is required for all procedures when Dentegra is the secondary carrier.

Procedure codes:
D2710–D2794

Description of service:
Crowns