D2330

• RESIN-BASED COMPOSITE - ONE SURFACE, ANTERIOR

WARNING

1. It is misleading to report individual composite restorations (D2330-D2335) for "splinting" of anterior teeth for periodontal reasons. D4322/D4323 are used to report splints for treatment of periodontally involved teeth. For splints associated with the stabilization of traumatic injury, see D727

2. Do not report D2330 for implant access hole closure. See D6197.

3. It is necessary to disclose the reason for a restoration if its purpose is to close a diastema or to improve esthetics/cosmetics where caries and/or fracture is not involved. These situations are addressed in, and limited by, third party contracts. Most payors require that decay and/or fracture be present to justify reimbursement. To provide a cosmetic service and report them as anterior composites restorations (D2330-D2335) to gain reimbursement could be considered fraud.

4. It is misleading to report composite restorations built to full contour as core buildups (D2950). Core buildups (after the tooth is 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 placement.

5. When two or more separate restorations are performed on the same tooth on the same date of service, report the restorations 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. For instance, an MO and separate DO is converted to an MOD for payment.

WATCH

D2330 reports the one surface restored incisal "edge," not the multi-surface incisal "angle." For incisal "angle" (the corner of an anterior tooth), report D2331-D2335 as appropriate based on the number of surfaces involved.

COMMENTS

1. Pins, if placed in an anterior restoration, are billed separately. See D2951.

2. All resin composite codes include light curing, bonding, and any acid etching in the overall restoration fee. The composite restoration codes also include any bases, liners, polishing, and occlusal adjustments provided for the tooth being restored.

3. D2330 may be used to report closing endodontic access through an anterior crown when composite resin 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. Resin-based composite (D2330) for an anterior tooth is reimbursed when decay and/or fracture are present in one surface of an anterior tooth (primary or permanent).

2. Pulp caps (D3110/D3120), when provided, are typically considered a part of, and are included in, the composite restoration fee. Note: there is a difference between a base/liner (which decreases sensitivity and protects the pulp) and a pulp cap. A pulp cap may be used to promote healing and repair of the pulpal tissue, and may assist in the formation of secondary dentin. If the service provided is a base or liner as a part of an amalgam or composite, do not submit a pulp cap for reimbursement. See D3110/D3120 for further details. Most PPOS disallow pulp caps (the patient may not be charged).

3. Class V restorations are typically reimbursed as single surface facial or lingual restorations.

4. Glass ionomers, when used as restorations, are reported as resin-based composites.

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

TIPS

Report D2330 when restoring an endodontic access opening of an anterior natural tooth, crown, or the access opening for the internal bleaching (D9974) of an anterior natural tooth with a resin restoration. If performed for endodontic access closure of a crown, state, "An occlusal composite resin was placed for endodontic access clo- sure." Do not report core buildup (D2950) or prefabricated post and core when restoring and closing an endodontic access opening where the crown is intact and in place. Core buildups and prefabricated post and core are reim- bursable 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 a composite 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 crown fee. Some payors deduct the fee for the restoration (in addition to patient co-pay) from the subsequent crown procedure if the restoration was placed within 12 to 24 months prior to the crown being seated.