Most common D4263 code reviews : HbA1c in-office, point-of-service testing - not covered, Removal of implant; superficial (e.g., buried wire, pin, or rod) (Separate procedure) or Accession of tissue, gross examination, preparation and transmission of written report.
Prophylaxis-adult. For payment purposes, the distinction between the adult and child dentition is determined by contract. Any fee in excess is Disallowed and not chargeable to the Patient. In the absence of group contract language regarding age, a person age fourteen (14) and older is considered an adult for benefit determination purposes of a prophylaxis-adult.
Separation of one or more connections between abutments and/or pontics when some portion of a fixed rosthesis is to remain intact D4263 and serviceable following sectioning and extraction or other treatment Includes all recontouring and olishing of retained portions.
In lieu of surgery, the formation of a pathway to achieve an apical seal without surgical intervention ecause of a non-negotiable root canal blocked by foreign bodies,D4263 included but not limited to separated instruments, broken posts or alcification of 50% or more of the roots.
Sealant repair - per tooth - This procedure is disallowed when performed by the same dentist/dental office based on the same time limitation that exists for replacement of a sealant. It is allowed at 50% of D4263 when performed by a different provider or if after the time limitation for the same dentist.
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