A written description of the service provided that is prepared when the term “by report” is included in a procedure code nomenclature; may be requested by a third-party payer to provide additional information for claims processing.
Services and supplies which are reimbursed in whole or in part under the conditions of the dental benefit plan, subject to all the terms and conditions of the agreement or insurance policy. Charges are subject to any contractual agreements, exclusions and limitations. Any charges not covered by the plan are considered non-covered charges.