Welcome to the Delta Dental of Rhode Island network
Delta Dental of Rhode Island is pleased to welcome the following recently credentialed dentists to our network:
Rusul Abdulrazzaq, DDS
Providence Community Health Centers
Ahmed Adbelaal, DDS
Affordable Dentures & Implants
Heba Alani, DMD
Diamond Hill Dental
Omar Alfaro, DDS
Dental Associates of Rhode Island
William Arden, DDS
Family and Cosmetic Dentistry
Shanky Balchandani, DDS
Comprehensive Community Action Program
Nicole Balthazar, DMD Dutchman Dental
Christine Barry, DMD
Comprehensive Community Action Program
Jessica Berman, DDS
Children’s Dentistry of East Greenwich & Children’s Dentistry of Coventry
Vlad Botezatu, DMD
Reservoir Dental
Miranda Boynton, DMD
Cumberland Dental Specialists
Paola Buckley, DMD
Dental Associates of Cumberland
David Choi, DMD
Sunny Smile Group III
Seungyeon Choi, DMD
Blackstone Valley Community Health Care
Hardik Dholakiya, DMD Thundermist Health Center
John Fitzsimons, DMD
WellOne Primary Medical and Dental Care
Aly Gamee, DMD
Thundermist Health Center
Did
Customer service excellence
Our customer service team answers calls in an average of just 2 seconds. We also offer a speed pass for participating dental offices, ensuring quicker access to assistance. Plus, our 24/7 Interactive Voice Response (IVR) system provides benefit information, including FaxBack services, for your convenience.
Romeo Ghraieb, DMD
Arrowhead Dental Associates
Gabriel Grisham, DMD
University Oral & Maxillofacial Surgery
Adrianna Gyorfi, DMD
Comprehensive Community Action Program
Jacquelyn Hadi, DMD
Frenchtown Dental Associates
Jordan Henry, DMD
Neetu Kainth DMD & Associates
Woodlyn Joachim, DMD
Thundermist Health Center
Wonsuk Joo, DMD
Elite Dentistry of Rhode Island
Erica Kleinbaum, DMD Periodontics Inc.
Mili Koirala, DMD
Rhode Island Dental LTD
Rose Liou, DMD
Thundermist Health Center
Guilbert Maria, DMD
Bright Dents LLC
Irma Nalic, DMD Thundermist Health Center
Hannah Namgung, DDS Thundermist Health Center
Ellen Nordgren, DDS
Newport Dental Associates
Vasseur Kamseu Noukeu, DMD Thundermist Health Center
Lee Parks, DMD
Narrow River Endodontics
Paige Peterson, DMD
Arrowhead Dental Associates
Yaohsien Peng, DDS
Maple Avenue Family Dentistry
Brigette Rankin, DMD
Warwick Family Dental
Olga Raptis, DMD
Children’s Dentistry of East Greenwich
Nina Razavi, DMD
Atwill Conroy
Barry Rosenberg, DMD
Children’s Dentistry of Westerly & Children’s Dentistry of Wakefield
Brianna Sammon, DMD
Mark S. Bichajian, DMD
Gayathri Shenoy, DMD
Coastal Dental Associates II
Mir Ayesha Siddiqua, DDS
Dental Associates of North Smithfield
Virali Soni, DMD
Thundermist Health Center
Neetika Thukral, DDS
Harrisville Dental Associates
Mohit Varma, DDS
Hagerty Dental Associates and Eric George, DMD & Associates
Josseline Herrera Velasco, DDS
Providence Community Health Centers
Lisa Vu, DMD
Coastal Dental Associates II
Matthew Wilks, DDS
Albert R. Arcand, DMD
Calvin Wilson, DDS
Calvin Wilson, DDS Affordable Dentures
Zeynep Yozgyur, DMD
Providence Community Health Centers
Plan utilization insights
98% of Delta Dental of Rhode Island members do not exceed their plan maximum. Additionally, less than 0.5% of claims are denied due to utilization review, reflecting our commitment to supporting your practice and patients effectively.
New dentist demographics
Delta Dental of Rhode Island welcomed 50 new dentists to our network thus far in 2024. The average age of the newly credentialed dentists is 36, with 70% under age 40. The dentists hail from 21 different dental schools, including a number of graduates from Tufts University, Boston University and the University of New England.
2024 dental awards
Congratulations to the following dentists for their recent induction to the American College of Dentists (ACD):
• Frederick A. Hartman, DMD
• Ernest P. Votolato, DMD
Brush up on commonly reviewed procedures
To expedite your pre-treatment estimates and payments, it’s important to submit all required documentation with your initial submission. To assist you with this process, we’ve prepared a Guide for Commonly Reviewed Procedures that includes the required documents needed for the most commonly reviewed procedures, as well as optional information that can help us process your claim more efficiently. We encourage you to print it out and keep it accessible in your office for quick reference.
To access the guide, visit the Dentists section at www.deltadentari.com or scan the QR code.
Delta Dental Premier® annual notice
The national Delta Dental Plans Association (DDPA) requires us to notify participating Delta Dental of Rhode Island dentists annually that they are automatically part of the national Delta Dental Premier® program. As a participant in this national program, you must accept the payment and claims processing policies set forth by the DDPA. Rhode Island participating Delta Dental Premier and Delta Dental PPO dentists are not allowed to balance bill beyond their approved maximum fee allowance (based on each product), except for noncovered services, services over the maximum or for alternate benefits. Participating dentists must accept their approved maximum fee allowance for members when the fee is not payable because of a deductible or for benefits with frequency limitations or waiting periods.
Note: Federal law makes the Rhode Island non-covered services statute inapplicable to claims covered by Delta Dental of California under the FED VIP contract. Balance billing for alternate benefits is not allowed.
Note: The national PPO program is an optional program for participating dentists and a separate contract is required.
Complete claim standard
To meet requirements for prompt and accurate claims processing, it’s important that providers submit certain information for a claim to be considered complete. Delta Dental of Rhode Island cannot process your claim until it meets our Complete Claim Standard. Our Complete Claim Standard outlines the requirements and timelines that all claims documentation must meet. To learn more, visit the Dentists section at www.deltadentalri.com and click on the Utilization Review Guidelines link.
2025 credentialing meeting schedule
Please ensure that your completed application is submitted at least 7 days before the scheduled meeting date. Only fully completed applications will be reviewed at the meeting. If your application is incomplete, it will be reviewed at the next available meeting date once all required documents have been received. Check the graphic below for specific meeting and application due dates.
MEETING DATE
January 15
February 12
March 12
April 9
May 14
June 11
July 16
August 13
September 17
October 15
November 12
December 10
January 14, 2026
January 8
February 5
March 5
April 2
May 7
June 4
July 9
August 6
September 10
October 8
November 5
December 3
January 7, 2026
2025 holiday schedule
Please make note of the following Delta Dental of Rhode Island corporate office closures.
January 1 (Wednesday) New Year’s Day
January 20 (Monday) Dr. Martin Luther King Jr. Day*
May 26 (Monday) Memorial Day
June 19 (Thursday) Juneteenth*
July 4 (Friday) Independence Day
August 11 (Monday) Victory Day*
September 1 (Monday) Labor Day
October 13 (Monday) Columbus Day/ Indigenous Peoples’ Day*
November 11 (Tuesday) Veterans Day (observed)*
November 27 (Thursday) Thanksgiving Day
November 28 (Friday) Day after Thanksgiving
December 25 (Thursday) Christmas Day
*Delta Dental of RI customer service office is open
Behind the smiles
There are so many people behind the bright, happy smiles across Rhode Island. We’re featuring professionals in the oral health industry who make a real impact.
Julie Galleshaw CDA, RDH, PHDH
Educating the dental hygienists of tomorrow, president of the Oral Health Coalition
Julie Galleshaw has been a practicing clinical dental hygienist for nearly 40 years and a full-time Dental Health faculty member at CCRI since 2002. Melissa Campbell of Rhode Island Health Center Association, describes
Julie as “Genuinely inspirational for her incredible leadership and dedication to oral health. From her work as a professor to her role as President of the Rhode Island Oral Health Coalition, she continually motivates others and strives for excellence in everything she does.”
Nominate a colleague
Is there someone in your office who deserves recognition? Nominate a dental professional that we can feature in a future publication. Send your submission, highlighting the nominee’s name, position, accomplishments/ impact on your office and picture to our professional relations team at professionalrelations@deltadentalri.com with the subject: Behind the Smiles.
Scan the QR code to learn more about the people behind the smiles.
New CDT codes take effect January 1, 2025
CDT 2025, an annual reference manual published by the American Dental Association (ADA), contains the following changes:
• 10 additions
• 3 revisions
• 2 deleted codes
This version is effective for services provided on or after January 1, 2025. To learn more about CDT 2025 or to order new materials for your office, visit www.adacatalog.org. Remember, these codes are used by all insurers to achieve uniformity, consistency and specificity in accurately reporting dental treatment.
Reminders
Help keep our records accurate
Accurate information helps us process your claims quickly and efficiently. When changes happen in your office, contact Debra Fernandes in our professional relations department at 401-752-6206, or email dfernandes@deltadentalri.com
Electronic attachments
Delta Dental accepts electronic attachments like X-rays, periodontal charting, narratives, and COB information using National Electronic Attachment, Inc. (NEA) services, Dental Xchange and Change Healthcare.
ADA dental claim form
To ensure your claim is processed without delay, please use the current ADA dental claim form.
Re-credentialing policy
When re-credentialing, please return the following documents:
• Your completed re-credentialing profile.
• A copy of the first page of your current professional liability insurance.
• An updated W-9 form if changes have been made.
Appeals and complaints
To learn more about our appeals and complaints processes, please visit the FAQs page https://deltadentalri.com/ Provider/PublicFAQ
Value-based care reimbursement
Value-based care payments are being reviewed and are scheduled to be distributed toward the end of the year.
Contact
Professional Relations
professionalrelations@deltadentalri.com
10 Charles Street, Providence, RI 02904-2208
Telephone: 401-752-6206
Fax: 401-752-6060
Website: www.deltadentalri.com
Visit deltadentalri.com to view the complete list of policies and procedures included in the Utilization Review Guidelines.
Policy/Procedure Changes Effective January 1, 2025
The following policy changes are required by the Delta Dental Plans Association to ensure consistent claims processing standards and will be effective January 1, 2025. In accordance with R.I. Law, the policy changes are presented in an edited (or “red line”) version. New language is underlined and deleted language is shown as a strikethrough. Please log in to your online account in the Dentists section of our website for the new version of our Utilization Review Guidelines incorporating these changes.
DIAGNOSTIC
Procedure Codes: D0220 - Intraoral periapical, first radiographic image; and D0230 - Intraoral periapical, each additional radiographic image
The fees for radiographs (D0220 and D0230) taken during the procedures and post-operative radiographs are included in the fees for root canals, crowns, onlays, bridges, inlays, and implants and are not billable to the patient by a participating dentist.
Procedure Code D6090 Repair of implant/abutment supported prosthesis
Covered at the Prosthodontic benefit level.
a. Fees for repair of implant/abutment supported prosthesis D6090, if performed within six months of the initial placement of the prosthesis, by the same dentist/dental office, are not billable to the patient by a participating dentist.
b. Repair of implant/abutment supported prosthesis D6090 is covered once every 60 24 months.
Procedure Code D9994 Dental case management – patient education to improve oral health literacy
Patient education is not a benefit and is DENIED. No payment is made for patient education to improve oral health literacy and the fees are not billable to the patient by a participating dentist when submitted on the same date of service as D1301 (immunization counseling), D1310 (nutritional counseling for control of dental disease), D1320 (tobacco counseling for the control and prevention of oral disease), D1321 (counseling for the control and prevention of adverse oral, behavioral, and systemic health effects associated with high-risk substance use) and D1330 (oral hygiene instructions).
RESTORATIVE
D2956 Removal of an indirect restoration on a natural tooth
Not to be used for a temporary or provisional restoration.
The removal of an indirect restoration is included in the definitive treatment and the fees are not billable to the patient by a participating dentist.
IMPLANT SERVICES
D6180 Implant maintenance procedures when a full arch fixed hybrid prosthesis is not removed, including cleansing of prosthesis and abutments
This procedure includes active debriding of the implant(s) and prosthesis. The patient is also instructed in thorough daily cleansing of the implant(s).
Benefits for D6180 are DENIED unless covered by group/individual contract.
If implant services and D6114 (implant /abutment supported fixed denture for edentulous arch – maxillary) and D6115 (implant /abutment supported fixed denture for edentulous arch – mandibular) are covered,
a. Benefit once every 36 months. Benefits for D6080 (Implant maintenance procedures when prostheses are removed and reinserted, including cleansing of prostheses and abutments) and D6180 are DENIED if done more frequently.
b. Fees for D6180 are not billable to the patient by a participating dentist if done within 12 months of D6114 and D6115.
D6193 Replacement of an implant screw
Benefits are DENIED unless implants are covered by group/individual contract. When covered:
a. Fees for replacement of an implant screw, if performed within six months of the initial placement of the prosthesis, by the same dentist/dental office, are not billable to the patient by a participating dentist.
b. Benefits are limited to once every 24 months.
c. Fees for D6089 (accessing and retorquing loose implant screw - per screw) are not billable to the patient by a participating dentist on the same date of services as D6193.
ORAL & MAXILLOFACIAL SURGERY
D7252 Partial extraction for immediate implant placement
Sectioning the root of a tooth vertically, then extracting the palatal portion of the root. The buccal section of the root is retained in order to stabilize the buccal plate prior to immediate implant placement. Also known as the Socket Shield Technique.
Benefits are DENIED unless covered by group/individual contract.
If implant services are covered:
Benefits are limited to once per tooth, in conjunction with immediate implant placement.
D7259 Nerve dissection
Involves the separation or isolation of a nerve from surrounding tissues. Performed to gain access to and protect nerves during surgical procedures.
a. Benefits for nerve dissection are DENIED as a specialized procedure.
b. Nerve dissection is part of D7241 (removal of impacted tooth - completely bony, with unusual surgical complications) and the fees are not billable to the patient by a participating dentist when done on the same date of service.
ORTHODONTICS
D8091 Comprehensive orthodontic treatment with orthognathic surgery
Treatment of craniofacial syndromes or orthopedic discrepancies that require multiple phases of orthodontic treatment including monitoring growth and development between active phases of treatment.
a. Benefits are DENIED when the supporting documentation does not meet the criteria for coverage.
b. Fees for limited orthodontic treatment (D8010 - D8040) and comprehensive orthodontic treatment (D8070D8090) when submitted on the same date of service as D8091 are not billable to the patient by a participating dentist.
D8671 Periodic orthodontic treatment visit associated with orthognathic surgery
Fees for D8671 are not billable to the patient by a participating dentist when done on the same date of service as D8091 comprehensive orthodontic treatment with orthognathic surgery.
ADJUNCTIVE GENERAL SERVICES
D9913 Administration of neuromodulators
Benefits for D9913 are DENIED unless covered by group/individual contract.
D9914 Administration of dermal fillers
Benefits for D9914 are DENIED unless covered by group/individual contract.
SLEEP APNEA SERVICES
D9959 Unspecified sleep apnea services procedure, by report
Benefit will be considered if Sleep Apnea Services are covered by group/individual contract.
Deleted Procedure Codes Effective January 1, 2025
D2941 interim therapeutic restoration – primary dentition
1. Allow once per primary tooth.
2. D2941 is not billable to the patient by a participating dentist when submitted by the same dentist/dental office in conjunction with definitive restoration within 24 months.
D6095 Repair implant abutment, by report
This procedure involves the repair or replacement of any part of the implant abutment.
Not a covered benefit unless the subscriber’s contract has an Implant Rider or single tooth implant benefit.
