Diagnostic & Preventive Benefits - Exclusions and Limitations Sample Clauses

Diagnostic & Preventive Benefits - Exclusions and Limitations. If the fee for a procedure or service is “Disallowed”, it is not payable by Delta Dental, nor collectable from the patient by a Participating Dentist. Participating Dentists agree not to charge a separate fee. • If the fee for a procedure or service is “Denied”, it is not payable by Delta Dental, but is chargeable to the patient as the procedure or service is not a benefit of the patient’s plan. 1. Charges for oral evaluations of any kind are Disallowed if performed within ninety (90) days after periodontal surgery, by the same Dentist/dental office. 2. Charges for oral evaluations for patients under age three (3) are Disallowed when performed on the same date of service by the same Dentist/dental office as a comprehensive evaluation. 3. Pre-diagnostic services, such as screening and assessment of a patient, are not covered benefits. Payment for a screening or assessment is Disallowed if billed with an oral evaluation. 4. A panoramic radiographic image, with or without supplemental radiographic image (such as periapicals, bitewings, and/or occlusals), is considered a complete series for time limitations. Any fee in excess of a fee for a complete series is Disallowed. 5. Unless there is evidence of trauma, charges for additional periapical and/or occlusal radiographic images within thirty (30) days of a complete series or panoramic image is Disallowed. 6. Fees for additional radiographic images taken by the same Dentist/dental office within sixty (60) days of vertical bitewings are Disallowed. 7. When benefits are requested for a panoramic radiographic image in conjunction with a complete series by the same Dentist/dental office, fees for the panoramic radiographic image are Disallowed as a component of the complete series on the same date of service. 8. Routine working and final treatment radiographic images taken for endodontic therapy by the same Dentist/dental office are considered a component of the complete treatment procedure. Separate fees are Disallowed on the same date of service. 9. The fee for a full mouth debridement is Disallowed when performed by the same Dentist/dental office on the same date of service as a comprehensive evaluation, detailed and extensive oral evaluation, or a comprehensive periodontal oral evaluation. 10. If the fee for bitewings, periapicals, itraoral occlusal or extraoral occlusal radiographic images is equal to or exceeds the fee for a full mouth series, it is considered a full mouth series for payment purposes and time...
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Diagnostic & Preventive Benefits - Exclusions and Limitations. If the fee for a procedure or service is “Not Billable to the Patient”, it is not payable by Delta Dental, nor collectable from the patient by a Participating Dentist. Participating Dentists agree not to charge a separate fee. • If the fee for a procedure or service is “Denied”, it is not payable by Delta Dental, but is chargeable to the patient as the procedure or service is not a benefit of the patient’s plan.
Diagnostic & Preventive Benefits - Exclusions and Limitations.  If the fee for a procedure or service is “Not Billable to the Patient”, it is not payable by Delta Dental, nor collectable from the patient by a Participating Dentist. Participating Dentists agree not to charge a separate fee. SAMPLE  If the fee for a procedure or service is “Denied”, it is not payable by Delta Dental, but is chargeable to the patient as the procedure or service is not a benefit of the patient’s plan. 1. Charges for oral evaluations of any kind are Not Billable to the Patient to the Patient, if performed within ninety (90) days after periodontal surgery, by the same Dentist/dental office. 2. Charges for oral evaluations for patients under age three (3) are Not Billable to the Patient when performed on the same date of service by the same Dentist/dental office as a comprehensive evaluation. 3. Pre-diagnostic services, such as screening and assessment of a patient, are not covered benefits. Payment for a screening or assessment is Not Billable to the Patient if billed with an oral evaluation. 4. A panoramic radiographic image, with or without supplemental radiographic images (such as periapicals, bitewings and/or occlusal), is considered a complete series for time limitations. Any fee in excess of the fee for a complete series is Not Billable to the Patient. 5. Unless there is evidence of trauma, charges for additional periapical and/or occlusal radiographic images within a thirty (30) day period of a complete series or panoramic image is Not Billable to the Patient. 6. Fees for additional radiographic images taken by the same Dentist/dental office within sixty (60) days of vertical bitewings are Not Billable to the Patient. 7. When benefits are requested for a panoramic radiographic image in conjunction with a complete series by the same Dentist/dental office, fees for the panoramic radiographic image are Not Billable to the Patient as a component of the complete series on the same date of service.

Related to Diagnostic & Preventive Benefits - Exclusions and Limitations

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