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Agmt98 Delta Dental
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Agmt98 Delta Dental
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Last modified
7/5/2005 2:59:37 PM
Creation date
5/20/2005 2:45:37 PM
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Agreement
Contractor Name
Delta Dental
PROJECT NAME
coverage for police officers & sergeants
RMP File Number
304
Date
2/2/1998
Reso Ref
13279
Box
5933
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<br />r-- ---- ----- <br /> <br />-------- - --------- -- - <br /> <br />----------- <br />-------- -- <br /> <br />03000-03999 -- ENDODONTICS <br /> <br />Pulpotomy <br /> <br />03220 <br /> <br />Therapeutic pulpotomy (excluding final restoration) <br /> <br />Root canal therapy (including treatment plan, clinical procedures, <br />and follow-up care) <br /> <br />03310 <br /> <br />03320 <br /> <br />03330 <br />03350 <br /> <br />anterior <br /> <br />(excluding <br /> <br />final <br /> <br />Root canal therapy <br />restoration) <br />Root canal therapy <br />restoration) <br />Root canal therapy -- molar (excluding final restoration) <br />Apexification/recalcification per treatment visit <br />(includes apical closure/calcific repair of perforations, <br />root resorption, etc.) <br /> <br />bicuspid <br /> <br />(excluding <br /> <br />final <br /> <br />Periapical services <br /> <br />0341.0 <br />03421 <br /> <br />03425 <br />03426 <br /> <br />03430 <br /> <br />03450 <br /> <br />Apicoectomy/periradicular surgery -- anterior <br />Apicoectomy/periradicular surgery bicuspid (first <br />root) <br />Apicoectomy/periradicular surgery -- molar (first root) <br />Apicoectomy/periradicular surgery (each additional root) , <br />by report <br />Retrograde filling per root, in addition to <br />apicoectomy/ periradicular surgery <br />Root amputation -- per root <br /> <br />Other endodontic procedures <br /> <br />03920 <br /> <br />--------- <br /> <br />Hemisection (including any root removal), not including <br />root canal therapy <br /> <br />4 <br /> <br />------ <br /> <br />------------- <br /> <br />------------ <br /> <br />----- <br />
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