D8702 - Repair Retain Man

Repair of fixed retainer, reattachment - mand.

Procedure Code
D8702
Category
Orthodontics

Insurance Verification Benchmarks & Billing Guidelines

Benchmark Policy Source: Delta Dental 2026

Frequency Limitation
Subject to group/individual contract frequency limitations (none)

Required Claim Attachments & Pre-Submission Checklist

  • Standard ADA claim form with CDT procedure code and date of service

Bill When (Allowable Clinical Criteria)

  • Indicated for medically and clinically necessary treatment as documented in patient's dental record.

Restrictions & Clinical Exclusions

  • The fee for D8702 is not billable to the patient within 24 months following placement of the fixed retainer by the same dentist/dental office.
  • Benefits for D8702 submitted after 24 months of placement are denied.
  • In the case where a different dentist/dental office is recementing/rebonding the fixed retainer a separate benefit may be given once per lifetime and benefits for any additional D8702 are denied.
  • All services and treatment provided remotely via tele-health modalities, be they synchronous or asynchronous, must be performed by a licensed dentist or their supervised staff, acting within the scope of applicable law. Services and treatment delivered virtually are only a benefit when the elements included in the descriptor of the CDT procedure code are completed and only when they meet generally accepted clinical guidelines.
  • Fees for final orthodontic records (images, photos, and models) are included in the treatment and not billable to the patient.
  • Benefits for restorations for altering occlusion, adjusting vertical dimension, replacing tooth structure lost by attrition, erosion, abrasion, abfraction, corrosion, TMD or for periodontal, orthodontic, or other splinting are denied, unless covered by group/individual contract. LIMITED ORTHODONTIC TREATMENT

Common Claim Denial Codes & Overturn Strategies

Denial CodeDenial ReasonAppeal & Overturn Strategy
CO-119Benefit maximum or frequency limitation exceeded for procedureSubmit clinical narrative detailing extraordinary circumstances, active recurrent pathology, or exception criteria.

ICD-10 Justification & Crosswalk Mappings

ICD-10 CodeDiagnosis NameCategoryPrimary JustificationClaim TypeClinical Scenario