Benefits Changes for 2018

PARSIPPANY, N.J. — November 1, 2017 — The following two changes will be effective for Delta Dental members as of January 1, 2018:

• Full mouth debridement (D4355) will be disallowed when provided on the same day by the same dentist/dental office as examination codes D0150, D0160, or D0180. This is consistent with the change in the CDT code D4355 descriptor language which now references these three exam codes for 2018.
• Two bitewing images (D0272) will be approved for patients under age 10. If codes D0273 or D0274 are submitted for a patient under age 10, they will be processed as D0272 and the fees in excess of D0272 will be disallowed.

The following five changes will apply to most new groups and many renewing groups starting in February 2018, but they will also remain unchanged for some members and groups. The choice of what type of benefits to include in a group’s dental plan is ultimately the decision of each group, and different groups may select different features for their coverage.

Please be sure to check the benefits for these specific procedures when verifying a member’s eligibility. All references to a 12-month benefit period may also refer to a calendar year benefit based on a member’s specific coverage:

• Benefits for bitewing radiographs will remain unchanged through age 18. The benefit for members over age 18 will change to one set of bitewings in 12 months.
• The benefit for D0210 will change from one set in 36 months to one set in 60 months.
• The benefit for D0330 will change from one in 36 months to one in 60 months.
• The benefit for topical fluoride application will change from one in 12 months to two in 12 months.
• Posterior composites will be covered and no longer alternate benefited to amalgams.

As a reminder, the fee for D1110, D1120, D4355, and/or D4910 may be DISALLOWED if the services are rendered by the same dentist/dental office within 30 days after the most recent scaling and root planing (D4341, D4342) or other periodontal therapy.


About Delta Dental

Delta Dental of New Jersey, Inc. is New Jersey’s leading dental benefits company, providing or administering coverage to more than 1.6 million people through contracts with groups in New Jersey and Connecticut. In Connecticut, Delta Dental of Connecticut, Inc. is a newly licensed insurer that writes dental coverage on an insured basis, and Delta Dental of New Jersey administers self-funded dental benefit programs. For more information, visit www.deltadentalnj.com.