3/1/2012

Effective:  January 1, 2012, the following changes were made to the Dental Program:

1. Non-emergency oral examinations (D0150, D0120) are limited to two per calendar year whether it is a comprehensive oral examination and one periodic oral examination or two periodic oral examinations in a 12-month period.
2. For procedure D1351, teeth to be sealed must be free of caries and restorations.  The surface sealed must be noted on the dental claim form.  Reimbursement for restorations placed on a previously sealed surface by the same provider within a 12-month period will be reduced by the amount of the reimbursement for the sealant.
3. For procedure codes D2140, D2150, D2160, D2161, D2330, D2331, D2332, D2335, D2391, D2392, D2393 and D2394, the reimbursement is based on the total number of unique surfaces restored, not to exceed the total number of surfaces characteristic of that tooth, and no surface shall be billed twice.  Reimbursement is not based on the total number of restorations placed.  For example, if a buccal, occlusal and lingual resin restoration was placed on a posterior tooth, the correct billing code would be BOL D2393 and not D2391 times three.
4. D2792, D2752, D2751 and D2750 pay only one code per tooth per lifetime.

This information is also available on the Agency’s website at www.medicaid.alabama.gov under Programs/Medical Services/Dental.

Questions about these changes should be directed to Leigh Ann Hixon, LeighAnn.Hixon@medicaid.alabama.gov, or by telephone at (334) 353-3031.