D2331

• RESIN-BASED COMPOSITE - TWO SURFACES, ANTERIOR

WARNING

1. It is misleading to report individual composite restorations (D2330-D2335) for "splinting" of anterior teeth for periodontal reasons. D4322/D4323 report splints for treatment of periodontally-involved teeth. For splints used in stabilization after traumatic injury, see D7270.

2. 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 composite restorations (D2330-D2335) to gain reimbursement may be considered fraud.

3. 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.

4. 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.
 

WATCH

1. Certain payors may not reimburse anterior multi-surface composite codes, but convert them to a one-surface composite (D2330) for reimbursement. Always report the correct multi-surface code and let the payor re-map for reimbursement purposes

2. D2331 is used to report a two surface restoration. One of the surfaces may be the incisal "edge" such as Fl. 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 adjustment provided for the tooth being restored.

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

LIMITATIONS

1. Resin-based composite (D2331) for an anterior tooth is reimbursed when decay and/or fracture are present in two surfaces 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. Glass ionomers, when used as restorations, are reported as resin-based composites.

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

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.