Blue Cross Blue Shield FEP Dental
Class D Orthodontic

D0340 Cephalometric film – may be allowed if completed more than 3 months prior to the start of orthodontic treatment

D0350 Oral/facial images (including intra and extraoral images) – may be allowed if completed more than 3 months prior to the start of orthodontic treatment

D0351 3D photographic image – may be allowed if completed more than 3 months prior to the start of orthodontic treatment

D0470 Diagnostic casts – may be allowed if completed more than 3 months prior to the start of orthodontic treatment

D7283 Placement of device to facilitate eruption of impacted tooth, covered 1 per lifetime

D8010 Limited orthodontic treatment of the primary dentition

D8020 Limited orthodontic treatment of the transitional dentition

D8030 Limited orthodontic treatment of the adolescent dentition

D8040 Limited orthodontic treatment of the adult dentition

D8070 Comprehensive orthodontic treatment of the transitional dentition

D8080 Comprehensive orthodontic treatment of the adolescent dentition

D8090 Comprehensive orthodontic treatment of the adult dentition

D8210 Removable appliance therapy

D8220 Fixed appliance therapy

D8660 Pre-orthodontic treatment visit

D8670 Periodic orthodontic treatment visit (as part of contract) – monthly payments automatically made if orthodontic treatment plan is in place

D8681 Removable orthodontic retainer adjustment

D8690 Orthodontic treatment (alternative billing to a contract fee) – paid as part of orthodontic treatment plan