EmblemHealth is committed to maintaining the highest level of quality in our dental plan(s) and meeting applicable state and federal requirements. We also strive to improve member and provider experience. To support our participating dentists and help ensure our dental plans continue to cover appropriate, affordable care, EmblemHealth commercial dental plans will implement the following changes on March 7, 2025:
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.
JP 67789 12/2024