Originally posted Dec. 5, 2024.
EmblemHealth is dedicated to providing high-quality dental coverage while adhering to state and federal requirements. We are also committed to enhancing the experience for both members and providers.
The following changes to our commercial dental plans were originally scheduled to take effect on March 7, 2025. However, the effective date has been postponed. A new implementation date will be communicated to participating providers once it has been established.
Frequency Changes/Limitations
- The frequency of fillings (D2140-D2430) will change from once every six months to once every 12 months on the same tooth, by the same provider. This frequency change from once every six months to once every 12 months will also apply to inlays, onlays, veneers, crowns, or crown retainers performed after a history of filings on the same tooth, by the same provider, in the last 12 months.
- Closure of an oroantral fistula or a sinus perforation (D7260-D7261) will change from no frequency limit to a frequency limitation of once every 12 months per quadrant.
We will notify participating providers as soon as a new effective date is determined. Thank you for your understanding and continued partnership.