Treatment Planning & Protocols Flashcards
7 cards from real CDC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Treatment Planning & Protocols flashcards as text
A provider submits a claim for tooth #31 crown (D2740) with a concurrent periodontal maintenance visit (D4910) on the same date of service. What is the consultant's most appropriate action?
Answer: Review for bundling or same-day service policy provisions before adjudicating
Same-day service policies vary by plan; the consultant should apply the applicable bundling and coordination-of-benefits rules before making a determination.
A patient presents with a cracked tooth syndrome diagnosis on tooth #18. The provider proposes a full-coverage crown. What documentation should the consultant require to support this treatment?
Answer: Clinical findings including transillumination results, bite test data, radiographs, and description of symptoms
Cracked tooth syndrome is a clinical diagnosis; supporting documentation should include symptom history, diagnostic tests, and radiographic findings.
Under evidence-based treatment planning protocols, what is the recommended re-evaluation interval following active periodontal therapy before initiating restorative treatment?
Answer: Four to eight weeks post-SRP to assess tissue response and residual pocket depths
A 4–8 week re-evaluation allows tissue healing and reassessment of periodontal status before committing to restorative treatment.
A dental plan covers implants with a combined annual maximum shared with other dental services. A member has used $1,200 of a $2,000 annual maximum and submits a $3,500 implant claim. What is the correct benefit calculation?
Answer: Pay $800 — the remaining annual maximum after previous expenditures
Benefits are limited to the remaining annual maximum; the member receives $800 toward the implant claim.
Which of the following best describes the dental consultant's role when reviewing a case referred for a second-opinion examination?
Answer: To provide an independent, objective clinical assessment to support the claims determination process
The second-opinion examiner provides an independent clinical assessment to assist the consultant in making an objective, evidence-based determination.
A treatment plan for a pediatric patient includes stainless steel crowns (SSCs) on multiple primary molars with extensive caries. The dental consultant's review should prioritize:
Answer: Assessing clinical documentation to confirm caries extent justifies SSC vs. alternative restorations
SSCs on primary teeth require clinical justification based on caries extent, expected retention time, and restorability of the tooth.
A dental treatment plan includes a crown lengthening procedure (D4249) prior to a crown on tooth #9. Which factor most strongly supports approval of the crown lengthening?
Answer: Inadequate clinical crown length due to subgingival caries or fracture requiring crown placement
Crown lengthening is clinically justified when inadequate tooth structure above the gingival margin prevents proper restoration margin placement.