In dentistry, as with other medical professions, many of the words used to describe dental procedures stem from Greek and Latin. One such word is “prophylaxis,” which comes from the Greek word, prophylaktikós, and means “to keep guard before,” or “to prevent/protect.” You may recognize it more readily as the adjective “prophylactic.” In dentistry, it is used to describe the process of protecting your teeth from disease and decay, and is rarely used around the office. You know it more colloquially as a simple dental “cleaning.”
No matter how vigilant one's oral care regime, the irrepressible development of plaque, and the porous nature of teeth makes them prone to decay. To forestall the excessive development of plaque that can result in gum loss, routine prophylaxis is recommended for all individuals. This dental procedure code applies to dental cleanings for children. The number of dental cleanings covered in a year is entirely up to the discretion of your insurance carrier, and if you require more than a semi-annual visit to the dentist for a cleaning, you may want to check with your provider to see if additional visits beyond those first two are covered.
The American Dental Association's description for Prophylaxis-Child is: "A dental prophylaxis performed on primary or transitional dentition only, which includes scaling and polishing procedures to remove coronal plaque, calculus, and stains.”
Avoiding dental parlance, this simply means the code provides for using dental tools and polishing procedures to remove plaque, tartar and stains from the portion of the tooth that extends above the gumline. Thus, if you are reviewing your insurance company statement and see codes other than this on the report, despite the fact that you requested just a cleaning for your child, you'll want to note that this code covers only the cleaning of your teeth as denoted above. Tasks performed on your child's teeth below the gumline or outside the definition provided above are commonly allowed solely at the discretion of your insurance carrier.
In order to avoid any confusion, some dental professionals have suggested an “exam” be scheduled as opposed to a “cleaning” to ensure a more accurate evolution of billing when it comes to a visit to the dentist – particularly when that visit extends beyond the care allowed under this code. Additionally, some carriers rank children over the age of 14 as adults when it comes to cleanings (Dental Procedure Code - Adult Prophylaxis), which may impact what you see on your statement as well.