Insurance coverage tables

The tables below show a breakdown of the procedures, categories, deductibles, and coverage percentages in the five default insurance coverage tables that are included in Dentrix.

Note: All procedures default to a pre-authorization amount of 0.00 and no co-pay.

You can add to and edit the coverage tables in the Office Manager.

You can also print the Standard Coverage Tables Report from the Office Manager. (This printed list includes any changes you made by adding to or editing the coverage tables.)

The five standard coverage tables below are:

·        Default Coverage Table

·        All Procedures (Cap Plan)

·        ADA Categories

·        Basic, Major, Ortho, Adj Gen

·        ADA Sub-Categories

1. Default Coverage Table

 

Beginning Procedure

Ending Procedure

Category

Coverage %

Deductible

D0100 -

D1999

Diagnostic/Preventive

100

Preventive

D2000 -

D2699

Basic Restoration

80

Standard

D2700 -

D2999

Crowns/Major

50

Standard

D3000 -

D3999

Endodontics

80

Standard

D4000 -

D4999

Periodontics

80

Standard

D5000 -

D5899

Prosthodontics, removable.

50

Standard

D5900 -

D5999

Maxillofacial. Prosthodontics

50

Standard

D6000 -

D6199

Implants

50

Standard

D6200 -

D6999

Prosthodontics, fixed

50

Standard

D7000 -

D7999

Oral Surgery

80

Standard

D8000 -

D8999

Orthodontics

50

Other

D9000 -

D9999

Adjunct general services

80

Standard

2. All Procedures (Cap Plan)

This coverage table contains every procedure code at a 100% coverage. The table below shows an example of this coverage table. (See

Beginning Procedure

Ending Procedure

Procedure Code

Coverage %

Deductible

D0120 -

D0120

Periodic Oral Examination

100

Preventive

D0140 -

D0140

Limited Oral Examination

100

Preventive

3. ADA Categories (12)

 

Beginning Procedure

Ending Procedure

Category

Coverage %

Deductible

D0100 -

D0999

Diagnostic

80

Preventive

D1000 -

D1999

Preventive

80

Preventive

D2000 -

D2999

Restorative

80

Standard

D3000 -

D3999

Endodontics

80

Standard

D4000 -

D4999

Periodontics 

80

Standard

D5000 -

D5899

Prostho, remov. 

80

Standard

D5900 -

D5999

Maxillofacial

80

Standard

D6000 -

D6199

Implant Serv.

80

Standard

D6200 -

D6999

Prostho, fixed

80

Standard

D7000 -

D7999

Oral surgery 

80

Standard

D8000 -

D8999

Orthodontics 

80

Other

D9000 -

D9999

Adj general ser 

80

Standard

4. Basic, Major, Ortho, Adj Gen

 

Beginning Procedure

Ending Procedure

Category

Coverage %

Deductible

D0100 -

D4999

Basic

80

Standard

D5000 -

D7999

Major

80

Standard

D8000 -

D8999

Orthodontics 

80

Other

D9000 -

D9999

Adj General Ser 

80

Standard

5. ADA Sub-Categories

 

Beginning Procedure

Ending Procedure

Category

Coverage %

Deductible

D0120 -

D0180

Evaluations

80

Preventive

D0210 -

D0363

Radiographs

80

Preventive

D0415 -

D0470

Tests & Exams

80

Preventive

D0472 -

D0999

Oral Path. Lab

80

Preventive

D1110 -

D1120

Prophylaxis

80

Preventive

D1201 -

D1206

Fluoride treat. 

80

Preventive

D1310 -

D1351

Other prevent.

80

Preventive

D1510 -

D1555

Space mainten.

80

Preventive

D2140 -

D2161

Amalgam restor. 

80

Standard

D2330 -

D2394

Resin restorat. 

80

Standard

D2410 -

D2430

Gold foil rest. 

80

Standard

D2510 -

D2664

Inlay/onlay

80

Standard

D2710 -

D2799

Crowns 

80

Standard

D2910 -

D2999

Oth restorative 

80

Standard

D3110 -

D3120

Pulp capping 

80

Standard

D3220 -

D3221

Pulpotomy 

80

Standard

D3230 -

D3240

Endo, primary

80

Standard

D3310 -

D3333

Endo therapy 

80

Standard

D3346 -

D3348

Endo retreatm.

80

Standard

D3351 -

D3353

Apex/recalcif.

80

Standard

D3410 -

D3470

Apico/Perirad

80

Standard

D3910 -

D3999

Oth endodontic

80

Standard

D4210 -

D4276

Surgical serv.

80

Standard

D4320 -

D4381

Non-surg Perio

80

Standard

D4910 -

D4999

Oth periodontal 

80

Standard

D5110 -

D5140

Comp. dentures

80

Standard

D5211 -

D5281

Part dentures

80

Standard

D5410 -

D5422

Adj to dentures 

80

Standard

D5510 -

D5520

Rep comp dentur 

80

Standard

D5610 -

D5671

Rep part dentur 

80

Standard

D5710 -

D5721

Denture rebase

80

Standard

D5730 -

D5761

Denture reline

80

Standard

D5810 -

D5821

Interm prosth

80

Standard

D5850 -

D5899

Oth rem prosth. 

80

Standard

D5911 -

D5999

Maxillof prosth 

80

Standard

D6010 -

D6050

Implant Service 

80

Standard

D6053 -

D6079

Implant prosth

80

Standard

D6080 -

D6199

Other Imp Serv

80

Standard

D6205 -

D6253

Fixed Pontics

80

Standard

D6545 -

D6634

Inlays/onlays

80

Standard

D6710 -

D6793

Crowns 

80

Standard

D6920 -

D6999

Oth fixed dent

80

Standard

D7111 -

D7140

Extractions

80

Standard

D7210 -

D7250

Surgic. extract 

80

Standard

D7260 -

D7294

Oth surgical 

80

Standard

D7310 -

D7321

Alveoloplasty

80

Standard

D7340 -

D7350

Vestibuloplasty 

80

Standard

D7410 -

D7415

Rem. tumors,etc 

80

Standard

D7440 -

D7465

Ex oss lesions

80

Standard

D7471 -

D7490

Excis. bone tis 

80

Standard

D7510 -

D7560

Surgic incision 

80

Standard

D7610 -

D7680

Fracture-simple 

80

Standard

D7710 -

D7780

Fracture-compnd 

80

Standard

D7810 -

D7899

Temp. joint dys 

80

Standard

D7910 -

D7910

Traumatic wound 

80

Standard

D7911 -

D7912

Complic. suture 

80

Standard

D7920 -

D7999

Oth repair proc 

80

Standard

D8010 -

D8040

Limited ortho

80

Other

D8050 -

D8060

Intercept ortho 

80

Other

D8070 -

D8090

Compreh. ortho

80

Other

D8210 -

D8220

Harmful habits

80

Other

D8660 -

D8999

Other ortho

80

Other

D9110 -

D9120

Unclassified 

80

Standard

D9210 -

D9248

Anesthesia

80

Standard

D9310 -

D9310

Consultation 

80

Standard

D9410 -

D9450

Profess. visit

80

Standard

D9610 -

D9630

Drugs

80

Standard

D9910 -

D9999

Miscellaneous

80

Standard