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MP 9.02 Dental Introduction

Medical Policy
Miscellaneous Policies
Original Policy Date
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This subsection of the Medical Policy Reference Manual includes policies pertaining to dental services and oral surgery.

Policies for dental services encompass those dental services required following acute accidental trauma.

Services routinely not covered are those dental services required for an injury resulting from chewing or biting.

Policies for oral surgery encompass non-dental surgical procedures for cleft lip and cleft palate, and for medical or surgical procedures occurring within or adjacent to the oral cavity.


Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract.  Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage.  Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.

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