Orthodontia Benefits
Orthodontia benefits can be complicated, but to simplify the benefit for your ease of use, the chart below can explain exactly what is covered, not covered and what is all inclusive. If you have questions, please contact HP Administrative Services LLC at 1-405-416-1800.
| Description | Benefit Clarification | |
|---|---|---|
| D8010 | Limited orthodontic treatment of the primary dentition | Covered and can bill separately |
| D8020 | Limited orthodontic treatment of the transitional dentition | Covered and can bill separately |
| D8030 | Limited orthodontic treatment of the adolescent dentition | Covered and can bill separately |
| D8040 | Limited orthodontic treatment of the adult dentition | Covered and can bill separately |
| D8050 | Interceptive orthodontic treatment of the primary dentition | Covered and can bill separately |
| D8060 | Interceptive orthodontic treatment of the transitional dentition | Covered and can bill separately |
| D8070 | Comprehensive orthodontic treatment of the transitional dentition | Covered and All Inclusive |
| D8080 | Comprehensive orthodontic treatment of the adolescent dentition | Covered and All Inclusive |
| D8090 | Comprehensive orthodontic treatment of the adult dentition | Covered and All Inclusive |
| D8210 | Removable appliance therapy | Covered and can bill separately |
| D8220 | Fixed appliance therapy | Covered and can bill separately |
| D8660 | Pre-orthodontic treatment visit | Covered and can bill separately |
| D8670 | Periodic orthodontic treatment visit | Not covered |
| D8680 | Orthodontic retention | Not covered |
| D8690 | Orthodontic treatment | Covered and can bill separately |
| D8691 | Repair of orthodontic appliance | Covered and can bill separately |
| D8692 | Replacement of lost or broken retainer | Covered and can bill separately |
| D8693 | Re-bonding or re-cementing; and/or repair, of fixed retainers | Covered and can bill separately |
| D8999 | Unspecified orthodontic procedure, by report | Each claim will be reviewed for coverage. Provide written description of dental necessity |
NOTE: All Inclusive: Includes retainer, appliances, etc.
Not covered (NC): This is the members responsibility
Last Modified on 12/12/2012