D2140

•  AMALGAM - ONE SURFACE, PRIMARY OR PERMANENT

• Used when decay or damage affects only a single surface of the tooth.
   

WARNING

1. It is misleading to report an amalgam restoration as a filling if the caries and preparation do not extend into the dentin and/or fracture is not involved. Restoration of an active cavitated lesion where the filling material is placed in enamel only (not extending into the dentin) is considered a preventive resin restoration (D1352), which would require a resin material. 

2. All bases, liners, adhesives, etching, polishing, contact and occlusal adjustments, and the use of caries detection agents are included in the overall amalgam restoration fee. If a pulp cap (D3110/D3120) is reported with an amalgam restoration placed on the same date of service, payors consider the pulp cap (as a base or liner) part of the restoration procedure. A pulp cap's purpose (promotion of healing and repair) is to assist in the formation of secondary dentin. A routine base or liner decreases sensitivity and protects the pulp. Pulp caps promote healing (secondary dentin) and repair. (See D3110/D3120 for further details.) Most PPOs disallow pulp caps (the patient may not be charged). 

3. It is necessary to disclose the reason for a restoration if its purpose is to treat abfraction, erosion, wear, abrasion, attrition, or to improve esthetics/cosmetics. These situations are addressed in, and limited by, most third-party contracts. Most payors require that decay and/or fracture be present to justify reimbursement for a restoration.

4. It is misleading to report amalgam restorations built to full contour as core buildups (D2950). Core buildups (after the tooth is fully prepared) are justified when they are necessary for the retention of the crown. A core buildup is followed by a temporary crown placement or final restoration.

5. When two or more separate restorations are performed on the same tooth on the same date of service, report each restoration separately. Reporting separate restorations on the same tooth is not considered unbundling. Always *report what you do." Note that many payors will limit reimbursement for restorations placed on the same tooth surface on the same service date.

6. Do not report D2140 for implant access hole closure. See D6197.

COMMENTS

1. Cervical restorations that extend into the dentin are typically considered a one surface restoration.

2. Report pins separately. See D2951.

3. D2140 may be used to report closing endodontic access through a crown when amalgam is used. See TIPS below for more details.

4. Enter the tooth number and surface being treated in the appropriate boxes of the 2024 ADA Dental Claim Form.
 

LIMITATIONS

1. The exclusion period for replacement of amalgam restorations is typically 24 to 36 months, depending on the contract. In some circumstances involving accidents, new caries, or radiation therapy the typical limitations may not apply. Should one of these situations exist and the reimbursement for the replaced restoration denied, or disallowed, appeal with a written narrative explaining the dental necessity. If a restoration is replaced within the limitation period by a different provider, the new provider may be reimbursed. This, however, is dependent upon contract language. 

2. Reimbursement for removing and replacing defective restorations may require that the treated tooth have decay, open margins, and/or fracture.

TIPS

Report D2140 when restoring an endodontic access opening of a natural tooth, crown, or the access opening for the internal bleaching (D9974) of a natural tooth with amalgam. If performed for endodontic access closure of a crown, state, "An occlusal amalgam was placed for endodontic access closure." Do not report core buildup (D2950) or prefabricated post and core when restoring and closing an endodontic access opening where the crown remains intact and in place. Core buildups and prefabricated post and core are reimbursable when they are necessary for the retention of the crown, not for closure of an endodontic access opening where the crown remains intact. Do not report crown repair necessitated by material failure either. If the crown is removed first or comes off, then core buildup/prefabricated post and core can be reported.

NARRATIVES

A crown placed after an amalgam restoration may be fully reimbursed (without the payor deducting the restoration fee from the crown fee) if an unexpected fracture of that tooth or failure of the restoration placed on that tooth is involved. Should this be the case, a narrative and/or appeal may be necessary to prevent the restoration fee from being deducted from the subsequent crown fee. Some payors deduct the fee for the