Providers:
Check out our monthly must-read designed to help you stay informed, save time and focus on patient care.
Cracking the code: D2950 cores
Do not report D2950 when the procedure only involves removing an undercut or correcting a concave irregularity in the preparation. In those cases, report D2949 (restorative foundation for an indirect restoration) instead. However, D2949 is generally not a covered benefit under most plans.
In addition, cores are not payable with inlays or three-quarter crowns. A core is also not separately payable when a post and core procedure (D2952 or D2954) is reported in conjunction with a crown.
Reminder: Clinical criteria information
It is our policy to adopt objective and evidence-based written clinical criteria to be referenced as guidelines when the administration of member dental plans requires professional determination of the medical necessity or clinical appropriateness of dental services.
Visit our “Clinical Criteria” page to find:
- Clinical criteria for utilization review determinations (adults)
- Clinical criteria for utilization review determinations (children)
- Clinical criteria documentation (by procedure)
Code update: D2710 (posterior crown coverage)
Porcelain and porcelain fused to metal (PFM) crowns placed on posterior permanent molars are considered a non-covered service under Medicaid. Claims submitted for these non-covered teeth may still be processed by Delta Dental but paid at a reduced rate.
For additional guidance on code usage and qualifications, please refer to your provider manual on Dental Office Toolkit™ (DOT).
Enroll in National EFT
Selecting National EFT as your direct deposit payment method means you can receive direct deposit payments from Delta Dental member companies nationwide and ensures faster reimbursement. Providers who participate in National EFT will have access within their DOT account to view payment details and EOBs for:
- Delta Dental of Arizona, Delta Dental of Indiana, Delta Dental of Michigan, Delta Dental of Minnesota, Delta Dental of Nebraska, Delta Dental of New Mexico, Delta Dental of North Carolina, Delta Dental of Ohio and Delta Dental of Tennessee
- Medicare Advantage only—Delta Dental of Illinois, Delta Dental of South Dakota, Delta Dental of Virginia and Delta Dental of Wisconsin
Special Healthcare Needs Benefit
Dental care is among the top unmet health needs for adults with intellectual and developmental disabilities. Delta Dental’s Special Healthcare Needs Benefit reduces barriers to care by providing eligible members with enhanced benefits, including additional dental visits, additional cleanings and treatment delivery modifications.
We offer opportunities to increase utilization of these services. Check a patient’s eligibility in DOT and sign up for our online continuing education course to learn more.
Medicaid: Emergency and post-stabilization services
Emergency dental care and post-stabilization services are reimbursable and do not require prior approval. Emergency dental care is considered unscheduled dental services necessary to treat a life-threatening condition in the mouth or face that occurs suddenly and requires immediate care in the dental office or emergency room, such as uncontrolled bleeding, severe spreading infection, severe debilitating pain, or severe traumatic injury to the mouth or face.
For more information, refer to sections 2 and 7 of your provider manual on DOT.
Healthy Kids Dental: Dental home assignments
Enhance member access
Delta Dental of Michigan is proud to serve as the sole carrier for Healthy Kids Dental (HKD) starting October 1. To enhance member access to care and support continuity of services, we will implement a dental home assignment approach for both current and new HKD members.
Flexible care
Members will continue to have the flexibility to receive care from any participating in-network provider, regardless of assignment.
Manage and support
We will carefully manage assignments based on network capacity and geographic access to help support a balanced and sustainable patient flow across participating providers. Additional details will be shared as implementation approaches.
Mailing address change: Delta Dental of Missouri, Delta Dental of South Carolina
Effective Aug. 1: Providers who treat Delta Dental of Missouri and/or Delta Dental of South Carolina members and need to submit paper claims and pre-treatment estimates can do so to the following address.
Delta Dental of Missouri
PO Box 70210
London, KY 40742
To avoid payment delays, we strongly encourage providers to enroll in National EFT through DOT.
Do you know your provider representative?
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Counties by representative
Upper Peninsula
- Alger
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- Houghton
- Keweenaw
- Marquette
- Ontonagon
Lower Peninsula
- Allegan
- Antrim
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- Benzie
- Berrien
- Branch
- Calhoun
- Cass
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- Eaton
- Emmet
- Leelanau
- Grand Traverse
- Hillsdale
- Ionia
- Isabella
- Jackson
- Kalamazoo
- Kalkaska
- Kent
- Lake
- Lenawee
- Manistee
- Mason
- Mecosta
- Missaukee
- Montcalm
- Muskegon
- Newaygo
- Oceana
- Osceola
- Ottawa
- St. Joseph
- Van Buren
- Washtenaw
- Wexford
Upper Peninsula
- Dickinson
- Gogebic
- Iron
- Menominee
Lower Peninsula
- Clinton
- Crawford
- Genesee
- Gladwin
- Gratiot
- Ingham
- Livingston
- Midland
- Oakland
- Otsego
- Roscommon
- Saginaw
- Shiawasee
Upper Peninsula
- Delta
- Chippewa
- Luce
- Mackinac
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Lower Peninsula
- Alcona
- Alpena
- Arenac
- Bay
- Cheboygan
- Huron
- Iosco
- Lapeer
- Macomb
- Monroe
- Montmorency
- Ogemaw
- Oscoda
- Presque Isle
- Sanilac
- St.Clair
- Tuscola
- Wayne