PrimeWest Health policy

Medical, Dental & Pharmacy > Dental > Covered Services

Medical, Dental & Pharmacy > Dental > Covered Services is a public PrimeWest Health policy. It lists 269 CPT or HCPCS codes. Not a coverage decision; the payer's own document governs.

View the original policy ↗

Payer
PrimeWest Health
Line of business
Medicaid
States
MN
Source
www.primewest.org

Codes in this policy

The CPT and HCPCS codes the policy names. A policy can name a code it excludes.

CodeOther PrimeWest Health policies
41899Policies naming 41899
D0120Policies naming D0120
D0140Policies naming D0140
D0145Policies naming D0145
D0150Policies naming D0150
D0210Policies naming D0210
D0220Policies naming D0220
D0230Policies naming D0230
D0270Policies naming D0270
D0277Policies naming D0277
D0330Policies naming D0330
D0340Policies naming D0340
D0364Policies naming D0364
D0372Policies naming D0372
D0384Policies naming D0384
D0396Policies naming D0396
D1110Policies naming D1110
D1120Policies naming D1120
D1206Policies naming D1206
D1208Policies naming D1208
D1330Policies naming D1330
D1351Policies naming D1351
D1354Policies naming D1354
D1355Policies naming D1355
D2140Policies naming D2140
D2161Policies naming D2161
D2330Policies naming D2330
D2394Policies naming D2394
D2720Policies naming D2720
D2721Policies naming D2721
D2722Policies naming D2722
D2740Policies naming D2740
D2750Policies naming D2750
D2794Policies naming D2794
D2950Policies naming D2950
D2952Policies naming D2952
D2953Policies naming D2953
D2960Policies naming D2960
D2961Policies naming D2961
D2962Policies naming D2962
D2971Policies naming D2971
D2975Policies naming D2975
D2991Policies naming D2991
D2999Policies naming D2999
D3310Policies naming D3310
D3330Policies naming D3330
D3346Policies naming D3346
D3348Policies naming D3348
D3355Policies naming D3355
D3356Policies naming D3356
D3357Policies naming D3357
D3460Policies naming D3460
D3999Policies naming D3999
D4210Policies naming D4210
D4211Policies naming D4211
D4240Policies naming D4240
D4241Policies naming D4241
D4245Policies naming D4245
D4249Policies naming D4249
D4260Policies naming D4260
D4261Policies naming D4261
D4263Policies naming D4263
D4264Policies naming D4264
D4266Policies naming D4266
D4267Policies naming D4267
D4268Policies naming D4268
D4270Policies naming D4270
D4271Policies naming D4271
D4273Policies naming D4273
D4274Policies naming D4274
D4275Policies naming D4275
D4276Policies naming D4276
D4322Policies naming D4322
D4323Policies naming D4323
D4341Policies naming D4341
D4342Policies naming D4342
D4346Policies naming D4346
D4355Policies naming D4355
D4381Policies naming D4381
D4910Policies naming D4910
D4999Policies naming D4999
D5110Policies naming D5110
D5120Policies naming D5120
D5130Policies naming D5130
D5140Policies naming D5140
D5211Policies naming D5211
D5212Policies naming D5212
D5213Policies naming D5213
D5214Policies naming D5214
D5221Policies naming D5221
D5222Policies naming D5222
D5223Policies naming D5223
D5224Policies naming D5224
D5225Policies naming D5225
D5226Policies naming D5226
D5227Policies naming D5227
D5228Policies naming D5228
D5820Policies naming D5820
D5821Policies naming D5821
D5862Policies naming D5862
D5864Policies naming D5864
D5866Policies naming D5866
D5867Policies naming D5867
D5875Policies naming D5875
D5899Policies naming D5899
D5911Policies naming D5911
D5912Policies naming D5912
D5937Policies naming D5937
D5951Policies naming D5951
D5952Policies naming D5952
D5953Policies naming D5953
D5954Policies naming D5954
D5958Policies naming D5958
D5959Policies naming D5959
D5960Policies naming D5960
D5982Policies naming D5982
D5983Policies naming D5983
D5984Policies naming D5984
D5985Policies naming D5985
D5986Policies naming D5986
D5987Policies naming D5987
D5992Policies naming D5992
D6010Policies naming D6010
D6011Policies naming D6011
D6012Policies naming D6012
D6013Policies naming D6013
D6040Policies naming D6040
D6050Policies naming D6050
D6055Policies naming D6055
D6056Policies naming D6056
D6057Policies naming D6057
D6058Policies naming D6058
D6059Policies naming D6059
D6060Policies naming D6060
D6061Policies naming D6061
D6062Policies naming D6062
D6063Policies naming D6063
D6064Policies naming D6064
D6065Policies naming D6065
D6066Policies naming D6066
D6067Policies naming D6067
D6068Policies naming D6068
D6069Policies naming D6069
D6070Policies naming D6070
D6071Policies naming D6071
D6072Policies naming D6072
D6073Policies naming D6073
D6074Policies naming D6074
D6075Policies naming D6075
D6076Policies naming D6076
D6077Policies naming D6077
D6080Policies naming D6080
D6082Policies naming D6082
D6083Policies naming D6083
D6084Policies naming D6084
D6086Policies naming D6086
D6087Policies naming D6087
D6088Policies naming D6088
D6092Policies naming D6092
D6093Policies naming D6093
D6094Policies naming D6094
D6097Policies naming D6097
D6098Policies naming D6098
D6099Policies naming D6099
D6120Policies naming D6120
D6121Policies naming D6121
D6122Policies naming D6122
D6123Policies naming D6123
D6190Policies naming D6190
D6194Policies naming D6194
D6195Policies naming D6195
D6205Policies naming D6205
D6210Policies naming D6210
D6211Policies naming D6211
D6212Policies naming D6212
D6214Policies naming D6214
D6240Policies naming D6240
D6241Policies naming D6241
D6242Policies naming D6242
D6243Policies naming D6243
D6245Policies naming D6245
D6250Policies naming D6250
D6251Policies naming D6251
D6252Policies naming D6252
D6253Policies naming D6253
D6545Policies naming D6545
D6548Policies naming D6548
D6624Policies naming D6624
D6634Policies naming D6634
D6710Policies naming D6710
D6720Policies naming D6720
D6721Policies naming D6721
D6722Policies naming D6722
D6740Policies naming D6740
D6750Policies naming D6750
D6751Policies naming D6751
D6752Policies naming D6752
D6753Policies naming D6753
D6780Policies naming D6780
D6781Policies naming D6781
D6782Policies naming D6782
D6783Policies naming D6783
D6784Policies naming D6784
D6790Policies naming D6790
D6791Policies naming D6791
D6792Policies naming D6792
D6793Policies naming D6793
D6794Policies naming D6794
D6920Policies naming D6920
D6940Policies naming D6940
D6950Policies naming D6950
D6985Policies naming D6985
D7220Policies naming D7220
D7230Policies naming D7230
D7240Policies naming D7240
D7241Policies naming D7241
D7251Policies naming D7251
D7272Policies naming D7272
D7280Policies naming D7280
D7283Policies naming D7283
D7290Policies naming D7290
D7291Policies naming D7291
D7490Policies naming D7490
D7510Policies naming D7510
D7880Policies naming D7880
D7899Policies naming D7899
D7953Policies naming D7953
D8010Policies naming D8010
D8020Policies naming D8020
D8030Policies naming D8030
D8040Policies naming D8040
D8070Policies naming D8070
D8080Policies naming D8080
D8090Policies naming D8090
D8091Policies naming D8091
D8210Policies naming D8210
D8220Policies naming D8220
D8660Policies naming D8660
D8670Policies naming D8670
D8671Policies naming D8671
D8680Policies naming D8680
D8681Policies naming D8681
D8696Policies naming D8696
D8697Policies naming D8697
D8698Policies naming D8698
D8699Policies naming D8699
D8701Policies naming D8701
D8702Policies naming D8702
D8703Policies naming D8703
D8704Policies naming D8704
D8999Policies naming D8999
D9110Policies naming D9110
D9222Policies naming D9222
D9248Policies naming D9248
D9410Policies naming D9410
D9610Policies naming D9610
D9612Policies naming D9612
D9630Policies naming D9630
D9910Policies naming D9910
D9920Policies naming D9920
D9941Policies naming D9941
D9952Policies naming D9952
D9956Policies naming D9956
D9957Policies naming D9957
D9971Policies naming D9971
D9972Policies naming D9972
D9973Policies naming D9973
D9974Policies naming D9974
D9999Policies naming D9999

All PrimeWest Health policies

Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.