Removal of Teeth
Clinical guideline governing when dental extractions (surgical and nonsurgical) are considered medically necessary and how they should be documented and coded for Anthem members; affects providers performing tooth extractions and Anthem dental benefit adjudicators.
Minor editorial refinements to description, clinical indications, criteria (added line #17), and reference; intent unchanged.
Medical Necessity Criteria for Tooth Removal
Initial extraction medical necessity
Covered when ALL of the following are met
See documentation module
From Clinical Indications section
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