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Akeso Oral Surgery - Catonsville

Welcome cosc4059 405 Frederick Rd Ste 9 Switch office
Catonsville, MD 21228

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Eligibility & benefits

Benefit search P
Benefit details
Benefit information is based on our records as of 01/20/2024
Benefit search
Enrollee name: Ayn Shin
Treatment history
Date of birth: 12/05/1979
Other procedures
Enrollee ID: 122371135601
Service forms KAISER FOUNDATION HEALTH PLAN, INC. - KAISER FOUND
Plan name:
HEALTH (USA)
Claim mailing address Plan number: 05454 - 00290
Delta Dental of California
Effective date: 05/09/2022
PO box 997330
Sacramento, CA 95899-7330 End date:
Claim payer ID : 77777 Eligibility status: Active

Program type: Delta Dental PPOTM

Select by Procedure code by Keywords by

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code

Enter procedure codes(up to 10, seperated by commas)

D9944, D9110, D9230 Search

Search result for D9944 D9110 D9230

Benefit summary

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Procedure Procedure Limitation Pre- Delta Dental Delta Dental Non-De

code code approval PPOTM Premier® Dental
description Dentist Dentist Dentist
(Benefi
based o

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contrac
allowan

Contract Contract Contrac

Age Age
Benefit Benefit Benefit
limit limit
Level Level Level

D9944 Occlusal Benefit is No 90% 90% 90%

guard - hard limited to
appliance, full one occlusal
arch guard within
a 5 year
period

D9110 Palliative Benefit is No 90% 90% 90%

treatment of limited to
dental pain - three within
per visit a 6 month
period

D9230 This procedure is not a benefit of most Delta Dental plans. The fee is the patient's
responsibility.

Treatment history

Procedure Procedure Limitation Limitation Service Tooth Tooth

code code text also applies date code description
description to

D9944 There are no claims on file for this member.

D9110 There are no claims on file for this member.

D9230 This procedure is not a benefit of most Delta Dental plans. The fee is the patient's
responsibility.

Current Dental Terminology (CDT) © American Dental Association (ADA). All rights reserved.

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