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Policy Updates for EmblemHealth Commercial Dental Plans
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
EmblemHealth is changing frequency limitations for dental procedures: fillings (D2140-D2430) will be limited to once every 12 months per tooth instead of every 6 months, and closure of oroantral fistula/sinus perforation (D7260-D7261) will be limited to once every 12 months per quadrant. The original March 7, 2025 effective date has been postponed with no new date announced yet.
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What to do
Action · 2 steps
01Monitor for EmblemHealth communication on new effective date: Update billing system to enforce 12-month frequency limits for fillings (D2140-D2430) on same tooth by same provider, and 12-month limits for oroantral fistula closures (D7260-D7261) per quadrant.
02Train billing team to verify treatment history before submitting claims to prevent denials for frequency violations.
Codes mentioned
D2140D2141D2150D2160D2161D2330D2331D2332D2335D2391D2392D2393D2394D2430D7260D7261
Original notice
Policy Updates for EmblemHealth Commercial Dental Plans
emblemhealth.com · Always check the source before changing claims.
Related changes
See all EmblemHealth changes →Policy Updates for EmblemHealth Commercial Dental PlansHighEffective Mar 7, 2025 · Provider NewsDental Provider Notification – Frequency of Fillings (D2140-D2430)MediumEffective Jan 1, 2027 · Provider NewsPolicy Update for Commercial Dental PlanLowEffective Jan 1, 2026 · Provider NewsPolicy Updates for EmblemHealth Commercial Dental PlansHighEffective Dec 6, 2024 · Provider NewsBrowse every EmblemHealth change in the policy list