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Sardoniosophy t1_j5v3eur wrote

Reply to comment by makeupobsessedlawyer in Dental Insurance which covers 4 cleaning per year? by aleshere

While I don't work in a dental office and I know certain insurance plans have a limitation on how many of something or what is covered, I have also been explicitly told both by my service providers, i.e. the dental or doctor's office, and my insurance that applying the right/correct code makes a difference in coverage. I could be being gaslit by both sides, but I'm just sharing what my experience has been and what I have been told. 🤷‍♀️

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yahabbibi t1_j5wmde2 wrote

The other commenter who works in dental billing is correct. There are frequency limitations on codes and a basic dental hygiene cleaning has only two codes for a basic prophy which is hand scaling and polishing: one code or adult patients (14 and up) and one for pediatric. A hygiene exam (w Dentist) is a separate code, fluoride is another. If your plan only covers 2 prophys per year (either 2x calendar yr or 2 6mo apart) and you're getting 4 for free your dental office is committing fraud by coding 2 of them as something else you have coverage for to get the insurance money. Root scaling? You'll need to look at your coverage and benefits and check the EOBs your carrier sends you after each service. If you only have 2 included in your plan and go 4 times for the dame service it should be coded exactly the same for all 4 visits. Fact.

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