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EMPLOYEE GROUP INS. RENEWALS -2012
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EMPLOYEE GROUP INS. RENEWALS -2012
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Last modified
2/16/2017 12:29:05 PM
Creation date
7/12/2013 10:31:02 AM
Metadata
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Contracts
Company Name
EMPLOYEE GROUP INS. RENEWALS
Contract #
A-2012-170
Agency
PERSONNEL SERVICES
Council Approval Date
8/6/2012
Expiration Date
12/13/2013
Destruction Year
2018
Notes
Amends A-2002-208 Amended by A-2014-176, A-2015-206, A-2015-207
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Miscellaneous services <br />D9910 Application of desensitizing medicament <br />D9911 Application of desensitizing resin for cervical and/or root surface, per tooth <br />D9920 Behavior management, by report <br />D9930 Treatment of complications (post-surgical) - unusual circumstances, by report <br />D9940 Occlusal guard, by report <br />D9941 Fabrication of athletic mouthguard <br />D9942 Repair and/or reline of occlusal guard <br />D9950 Occlusion analysis - mounted case <br />D9951 Occlusal adjustment - limited <br />D9952 Occlusal adjustment - complete <br />D9970 Enamel microabrasion' <br />D9971 Odontoplasty 1-2 teeth; includes removal of enamel projections <br />D9972 External bleaching - per arch <br />D9973 External bleaching - per tooth <br />D9974 Internal bleaching - per tooth <br />D9999 Unspecified adjunctive procedure, by report <br />Note: This Appendix represents codes and nomenclature excerpted from the version of Current <br />Dental Terminology (CDT) in effect at the date of this printing. CDT coding and nomenclature are the <br />copyright of the American Dental Association, and have been accepted as the standard for data <br />transmission purposes under federal Administrative Simplification regulations. For the purposes of <br />this Appendix, Delta Dental's administration of Benefits, Limitations and Exclusions under this <br />Contract will at all times be based on the then-current version of CDT whether or not a revised <br />Appendix B is provided. <br />15
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