Question

How often do dental plans typically cover D0160? Do we actually need to submit a report?

Frequency limitations for D0160 vary widely. Some dental plans only provide a benefit once per provider. Some map it to their D0150 frequency limit. Others consider it part of the two exams allowed per year. Likewise, some plans require a report whenever D0160 is submitted, while others only request a report if they feel it is being used too often. Also note that some plans require history of the previous comprehensive oral evaluation before paying for D0160.

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