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Dental HMO Continuing Orthodontic Treatment Request Form 10-22-14 (2)

Dental HMO Continuing Orthodontic Treatment Request Form 10-22-14 (2) 2025

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56 votes

The document is a request form for continuing orthodontic treatment coverage under SafeGuard Health Plans, Inc. It outlines the eligibility criteria, required documentation, and submission process for subscribers who are currently in active orthodontic treatment. The form must be completed by both the subscriber and the orthodontist, and submitted within thirty days of the plan's effective date to ensure coverage consideration.

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2017	4.8 Satisfied (56 Votes)
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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the ADA code for orthodontic visit?

CODE DEFINITION D8660 Pre-orthodontic treatment visit D8670 Periodic orthodontic treatment visit (as part of contract) D8680 Orthodontic retention (removal of appliances, construction and placement of retainer(s)).

What is Phase 2 of orthodontic treatment?

After phase 1 orthodontics, patients generally begin phase 2 of orthodontic treatment during early adolescent or adolescent years. During this phase of treatment, teeth are aligned for maximum esthetics, function and stability with braces and specialized retainers or expansion appliances, if needed.