Common use of Periodontal Services Clause in Contracts

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