CSHCN 2009 > Dental > Benefits and Limitations

14.2.2.5 Tests and Oral Pathology Procedures

The following procedure codes may be considered for reimbursement and are limited to clients 1 year of age or older:

Procedure code D0460 includes multiple teeth and contralateral comparisons based on medical necessity. Procedure code D0460 is considered part of any endodontic procedure and is not separately reimbursed when billed on the same date of service as any endodontic procedure.

Refer to: Section 14.2.5, "Therapeutic Services" for additional information about endodontic procedures.

When billing for diagnostic procedures not adequately described by other procedure codes, providers should use procedure code D0999. Only one emergency or trauma claim per client, per day may be submitted. Separate services may be submitted for the same client on the same date of service, one for emergency or trauma and one for nonemergency or routine care.

When billing electronically for emergency or trauma-related dental services, use the ET modifier indicating emergency.