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Does Delta Dental Cover Botox For TMJ?

No, Delta Dental does not cover botox for TMJ because no dental insurance covers it and there's no dental billing code for it either.


Delta dental has no TMJ botox coverage

Unfortunately, delta dental does not provide insurance coverage for botox injections to treat temporomandibular joint disorders. While delta does cover TMJ procedures, botox is NOT included.


Below is a typical breakdown for TMJ treatments that it covers.


Delta Dental TMJ coverage for each procedure

None of those dental codes are for botox treatments. In order to save you time looking up each code, the table below describes what each of them are.


Dental Billing Code

Procedure Description

D7840

Condylectomy

D7850

Surgical discectomy

D7852

Disc repair

D7854

Synovectomy

D7856

Myotomy

D7858

Joint reconstruction

D7860

Arthrotomy

D7865

Arthroplasty

D7870

Arthrocentesis

D7871

Non-arthroscopic lysis & lavage

D7872

Arthroscopy - with or without biopsy

D7873

Arthroscopy: lavage/lysis of adhesions

D7874

Arthroscopy: disc repositioning

D7875

Arthroscopy: Synovectomy

D7876

Arthroscopy: Discectomy

D7877

Arthroscopy: Debridement

D7880

Occlusal orthotic device

D7881

Occlusal orthotic device adjustment


Important note: Please take notice of the "limitations" in the benefit breakdown above which literally says every procedure except one, can only be done ONCE every 60 months. This means each of these TMJ procedures will be covered once every 5 years.

  • As you know, botox is temporary and only lasts about 3-6 months max.

  • That means you will need to have it reinjected on a routine basis.


What I'm trying to say is that even if delta dental covers it, you'll still be paying out of pocket for every subsequent visit! Over the course of 5 years, you may need up to 20 botox visits and if it covers it once every 5 years, that is not much help at all.


 

No dental billing code for TMJ botox injections

Ultimately the reason why delta dental does not cover botox for TMJ is because there is no dental billing code for it. This isn't unique to delta dental insurance because there isn't a single dental insurance that has it either.


4 boxes of 50cc botox

Unfortunately, it is currently not a recognized insurance billing procedure.


Every dental treatment/procedure has an associated billing code that is used to communicate with dental insurance as to what as done. This code usually starts with the letter "D" followed by a 4 digit numerical code.


Botox injections for temporomandibular joint treatment does not have such a code.


What this all means: What I'm trying to say is that TMJ botox treatment is not covered by dental insurance. If you elect to have this procedure done, you will have to pay out of pocket for it. The cost will depend on how many units you need to treat your condition.


 

Verdict

If you have delta dental, you shouldn't hold your breath hoping for TMJ botox coverage... but it really isn't their fault because no dental insurance has coverage for it. Nonetheless, our dentists in Long Island City do provide botox for TMJ so if you're in the area, make an appointment with us!

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About the author: Dr David Chen, DDS

Hello, I'm Dr Chen and I'm an actively practicing dentist in Long Island City, NY. I graduated from Columbia University College of Dental Medicine in 2016 but prior to going to dental school I was already working in the dental field. It's been more than a decade since I first got to know dentistry and let me tell you, time flies by quickly. Since then I've developed a fondness for writing, which is how this all got started!

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Medical Disclaimer:

This blog is purely meant for information purposes and should not be used as medical advice. Each situation in your mouth is unique and complex. It is not possible to give advice nor diagnose any oral conditions based on text nor virtual consultations. The best thing to do is to go in person to see your dentist for an examination and consultation so that you can receive the best care possible.

The purpose of all of this oral health information is to encourage you to see your dentist and to inform you of what you may expect during your visit. Due to the unfortunate nature of dentistry, there isn't really any true home remedies that will get rid of dental problems. Roughly 99.99% of them require in-person intervention by a healthcare professional.

Hint: That is the reason why you can't eliminate seeing dentists in your life!

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