Periodontal Services Sample Clauses
The 'Periodontal Services' clause defines the scope and terms under which dental services related to the prevention, diagnosis, and treatment of gum diseases are provided. It typically outlines which specific periodontal procedures are covered, such as scaling, root planing, or maintenance visits, and may specify any limitations, frequency, or pre-authorization requirements. This clause ensures that both the provider and the patient understand what periodontal care is included under the agreement, thereby reducing misunderstandings and clarifying coverage boundaries.
Periodontal Services. Services require prior authorization with submission of diagnostic materials and documentation of need.
a) Surgical services
1. Gingivectomy and gingivoplasty
2. Gingival flap including root planning
3. Apically positioned flap
4. Clinical crown lengthening
5. Osseous surgery
6. Bone replacement graft – first site and additional sites
7. Biologic materials to aid soft and osseous tissue regeneration
8. Guided tissue regeneration
9. Surgical revision
10. Pedicle and free soft tissue graft 11. Subepithelial connective tissue graft 12. Distal or proximal wedge 13. Soft tissue allograft
Periodontal Services i) Full mouth debridement - one (1) per lifetime.
ii) Periodontal maintenance following active periodontal therapy - two (2) per twelve
Periodontal Services. CONTRACTOR will provide dental treatment in accordance with the guidelines set forth by DEPARTMENT in ANNEX 1 (MSP Health Care Services Procedure documents PE 06.01-09, ANNEX 2 (MT DOC Guide to the Dental Chart) and ANNEX 4 (MT DOC Dental Services Guidelines).
Periodontal Services. 1. Periodontal surgery.
2. Periodontal sealing and root planing.
3. Special periodontal appliances, excluding appliances for treatment of temporal mandibular joint dysfunction.
Periodontal Services. Periodontal maintenance: Limited to a total of one periodontal maintenance or prophylaxis in any six consecutive month period. Allowance includes periodontal charting, scaling and polishing. Also see Prophylaxis under Prophylaxis And Fluorides in Group I Services. Periodontal Services: Allowance includes the treatment plan, local anesthetic and post- treatment care. Requires documentation of periodontal disease confirmed by both radiographs and pocket depth probings of each tooth involved. Scaling and root planing, per quadrant: Limited to once per quadrant in any 24 consecutive month period. Covered when there is radiographic and pocket charting evidence of bone loss. Full mouth debridement: Limited to once in any 36 consecutive month period. Considered only when no diagnostic preventive, periodontal maintenance procedure, periodontal service or periodontal surgery procedure has been performed in the previous 36 consecutive month period. Allowance includes the treatment plan, local anesthetic and post-surgical care. Requires documentation of periodontal disease confirmed by both radiographs and pocket depth probings of each tooth involved. Considered when performed to retain teeth. Treatment performed for a tooth or teeth with a guarded, questionable or poor prognosis is not covered. The treatment listed below is limited to a total of one of following, once per tooth in any 12 consecutive month period. • Gingivectomy or gingivoplasty, per tooth (less than three teeth). • Crown lengthening, hard tissue. The treatment listed below is limited to a total of one of the following, once per quadrant, in any 36 consecutive month period. • Gingivectomy or gingivoplasty, per quadrant. • Osseous surgery, including scaling and root planing, flap entry and closure, per quadrant. • Gingival flap procedure, including scaling and root planing, per quadrant. • Distal or proximal wedge procedure, not in conjunction with osseous surgery. • Surgical revision procedure, per tooth. The treatment listed below is limited to a total of one of the following, once per quadrant in any 36 consecutive month period, when the tooth is present, or when dentally necessary as part of a covered surgical placement of an implant. • Pedicle or free soft tissue grafts, including donor site. • Subepithelial connective tissue graft procedure. The treatment listed below is limited to a total of one of the following, once per area or tooth, per lifetime, when the tooth is present. • Guided tissue r...
Periodontal Services i) Non-surgical, surgical and adjunctive services (ODA 41101-41104, 41109, 41211-41214, 41219, 41221-41224, 41229, 41231-41234, 41239, 41301, 41302, 41309, 42111, 42201, 42311, 42321, 42331, 42339, 42411, 42421, 43431, 42441, 42511, 42521, 42531, 42611, 42711, 42811, 42819, 42821-42823, 42829, 43111, 43211, 43231, 43241, 43261, 43311-43314, 43319, 43421-43427, 43429). Perio- dontal appliances (ODA 43611, 43612, 43621-43623, 43629, 43631) (grinding habit) TMJ appliance (ODA 43711, 43712, 43721, 43722, 43731-43733, 43739, 43741) Periodontal Reevaluation (ODA 49101, 49102, 49109) Periodontal ▇▇▇▇▇▇- ▇▇▇▇ (▇▇▇ ▇▇▇▇▇, 49219)
Periodontal Services. Nonsurgical services, excluding training in personal therapeutic periodontal care.
Periodontal Services. Nonsurgical services, excluding training in personal therapeutic periodontal care. Surgical services. Post-surgical visits visits per year. adjustments for periodontal purposes only. Occlusal equilibration maximum of time units per lifetime. Subgingival scaling and/or root planing maximum of time units OR one full mouth per year. Special periodontal appliance for bruxism only. Repairs. Additions. Relines. Extractions uncomplicated and complicated. Removal of residual roots. Surgical exposure of teeth. Alveoloplasty, gingivoplasty, stomatoplasty and os- teoplasty. Surgical excisions. Surgical incisions. Treatment of fractures. Miscellaneoussurgical services excluding a surcharge for immediate insertion of dentures. House and hospital visit. Officevisit after regularlyscheduled hours and no opera- tive services performed. Injectionof drugs. Anaesthesia and sedation only when performed in conjunction with oral surgery. Inlays, crowns only if the tooth cannot be restored with a Basic Restoration. -transitional (temporary) crowns are considered part of the final restoration. limited to full metal crowns on molar teeth. Porcelain repairs. Retentive pins, post and cores. Recementation. Removal of crown or inlay. Retainer Abutment crowns and limited to full metal crowns and for molars.
Periodontal Services. 1 . Periodontal surgery.
Periodontal Services. Examinations Surgical Services Vital Pulpotomy ENDODONTIC SERVICES to incl.) Not Applicable in Quebec Emergency Procedures Other Procedures Surgical Exposure incl. Transplantation Repositioning Enucleation MAJOR SURGICAL SERVICES Alveoloplasty Gingivoplasty Stomatoplasty incl.