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The document also provides a code-to-description mapping for a wide range of dental procedures, including preventive evaluations, radiographic imaging series, prophylaxis and fluoride applications, and restorative treatments covering common restorative materials and complex crown or inlay/onlay options, each assigned an associated category 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service periodicity does the document specify for comprehensive dental visits?","Question",{"text":102,"@type":103},"It lists periodicity by benefit type, such as “Per year” for several comprehensive services and “Every 6 months” for oral exam and certain preventive services.","Answer",{"name":105,"@type":100,"acceptedAnswer":106},"Which preventive procedure codes are included?",{"text":107,"@type":103},"The document includes preventive codes such as D0120, D0140, D0150, D0160, D0170, D0180, and multiple radiographic imaging codes like D0210 through D0330.",{"name":109,"@type":100,"acceptedAnswer":110},"What types of restorative treatments are covered in the procedure code list?",{"text":111,"@type":103},"Restorative coverage includes amalgam and resin-based composite restorations, inlay/onlay options with multiple material types, and crown-related procedures, with corresponding code descriptions and a Restorative category label.","https://schema.org",{"og:url":78,"og:type":114,"og:title":59,"og:site_name":86,"og:description":61},"article",{"robots":116,"canonical":78},"index,follow",{"doc_id":118,"site_id":56},573948,1791955131,{"code":4,"msg":5,"data":121},{"doc_id":118,"user_id":122,"nickname":83,"user_avatar":123,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":124,"file_id":125,"file_url":126,"file_type":127,"file_size":128,"view_count":4,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":8,"language":129,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":130,"faqs":131,"seo_title":132,"seo_description":61,"update_tm":119,"read_time":79},2336474466412,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","2025 LIST OF COVERED DENTAL PROCEDURES Enabling A Life Well LivedTM  \n| Comprehensive Services |  |  |\n| --- | --- | --- |\n| Benefit | Number of Visits | Periodicity |\n| Restorative | 2 | Per year |\n| Endodontics | 2 | Per year |\n| Periodontics | 2 | Per year |\n| Prosthodontics | 2 | Per year |\n| Maxillofacial Prosthetics | 2 | Per year |\n| Implant Services | 2 | Per year |\n| Oral and Maxillocacial Surgery | 2 | Per year |\n| Orthodontics | 2 | Per year |\n\n\n| Comprehensive Services |  |  |\n| --- | --- | --- |\n| Benefit | Number of Visits | Periodicity |\n| Oral Exam | 1 | Every 6 months |\n| X-Rays | 2 | Per year |\n| Other Diagnostic Services | 2 | Per year |\n| Prophylaxis (Cleaning) | 1 | Every 6 months |\n| Fluoride Treatment | 1 | Per year |\n| Other Preventive Services | 2 | Per year |\n\n\n| Code | Description | Category |\n| --- | --- | --- |\n| D0120 | periodic oral evaluation-established patient | Preventive |\n| D0140 | limited oral evaluation-problem focused | Preventive |\n| D0150 | comprehensive oral evaluation-new or established patient | Preventive |\n| D0160 | detailed and extensive oral eval-problem focused, by report | Preventive |\n| D0170 | re-evaluation, limited problem focused | Preventive |\n| D0180 | comprehensive periodontal evaluation-new or established patient | Preventive |\n| D0210 | intraoral-comprehensive series of radiographic images | Preventive |\n| D0220 | intraoral-periapical first radiographic image | Preventive |\n| D0230 | intraoral-periapical each additional radiographic image | Preventive |\n| D0240 | intraoral-occlusal radiographic image | Preventive |\n| D0270 | bitewing-single radiographic image | Preventive |\n| D0272 | bitewings-two radiographic images | Preventive |\n| D0273 | bitewings-three radiographic images | Preventive |\n| D0274 | bitewings-four radiographic images | Preventive |\n| D0277 | vertical bitewings-7 to 8 films | Preventive |\n| D0330 | panoramic radiographic image | Preventive |\n| D1110 | prophylaxis-adult | Preventive |\n| D1206 | topical application of fluoride varnish | Preventive |\n| D1208 | topical application of fluoride-excluding varnish | Preventive |\n| D2140 | Amalgam-one surface, primary or permanent | Restorative |\n| D2150 | Amalgam-two surfaces, primary or permanent | Restorative |\n| D2160 | amalgam-three surfaces, primary or permanent | Restorative |\n| D2161 | amalgam-four or more surfaces, primary or permanent | Restorative |\n| D2330 | resin-based composite-one surface, anterior | Restorative |\n| D2331 | resin-based composite-two surfaces, anterior | Restorative |\n| D2332 | resin-based composite-three surfaces, anterior | Restorative |\n| D2335 | resin-based composite-four or more surfaces (anterior) | Restorative |\n| D2390 | resin-based composite crown, anterior | Restorative |\n| D2391 | resin-based composite-one surface, posterior | Restorative |\n| D2392 | resin-based composite-two surfaces, posterior | Restorative |\n| D2393 | resin-based composite-three surfaces, posterior | Restorative |\n| D2394 | resin-based composite-four or more surfaces, posterior | Restorative |\n| D2510 | inlay-metallic-1 surface | Restorative |\n| D2520 | inlay-metallic-2 surfaces | Restorative |\n| D2530 | inlay-metallic-3+ surfaces | Restorative |\n| D2542 | onlay-metallic-two surfaces | Restorative |\n| D2543 | onlay-metallic-3 surfaces | Restorative |\n| D2544 | onlay-metallic-4+ surfaces | Restorative |\n| D2610 | inlay-porce/ceramic-1surface | Restorative |\n\n\n| D2620 | inlay-porcelain/ceramic-2 surfaces | Restorative |\n| --- | --- | --- |\n| D2630 | inlay-porc/ceramic 3+ surfaces | Restorative |\n| D2642 | onlay-porcelain/ceramic-2 surfaces | Restorative |\n| D2643 | onlay-porcelain/ceramic-3 surfaces | Restorative |\n| D2644 | onlay-porcelain/ceramic-4+ surfaces | Restorative |\n| D2650 | inlay-composite/resin 1surface | Restorative |\n| D2651 | inlay-composite/resin-2 surfaces | Restorative |\n| D2652 | inlay-composite/resin-3+ surfaces | Restorative |\n| D2662 | onlay-composite/resin-2 surfaces | Restora","cbCaitX9cYX4deF6","https://ap.wps.com/l/cbCaitX9cYX4deF6","pdf",174501,"English","# Comprehensive Services\n## Benefit\n# Procedure Code List\n## Preventive\n## Restorative","[{\"question\":\"What service periodicity does the document specify for comprehensive dental visits?\",\"answer\":\"It lists periodicity by benefit type, such as “Per year” for several comprehensive services and “Every 6 months” for oral exam and certain preventive services.\"},{\"question\":\"Which preventive procedure codes are included?\",\"answer\":\"The document includes preventive codes such as D0120, D0140, D0150, D0160, D0170, D0180, and multiple radiographic imaging codes like D0210 through D0330.\"},{\"question\":\"What types of restorative treatments are covered in the procedure code list?\",\"answer\":\"Restorative coverage includes amalgam and resin-based composite restorations, inlay/onlay options with multiple material types, and crown-related procedures, with corresponding code descriptions and a Restorative category label.\"}]","2025 List of Covered Dental Procedures - Dental Benefit Coverage | PDF"]