D2391

• RESIN-BASED COMPOSITE - ONE SURFACE, POSTERIOR
• Used to restore a carious lesion into the dentin or a deeply eroded area into the dentin. Not a preventive procedure.

WARNING

1. It is misleading to report a resin-based composite restoration where air abrasion or fissurotomy is done without an active cavitated lesion present that extends into dentin. A diagnostic radiographic image or other documentation (photo/narrative) should be a part of the patient's record to support the presence of caries. It is misleading to report D2391 if occlusal caries and the preparation remain in the enamel. To report D2391, occlusal caries and preparation must extend into the dentin and/or a fracture into the dentin and is repaired by the restoration.

2. It is misleading to report composite restorations as core buildups (D2950). Composite restorations are built to full contour and have occlusion, anatomy and depending on the restoration often has proximal contacts. Core buildups on a fully prepared tooth are necessary if there is insufficient retention for a separate extracoronal restorative procedure, e.g., a crown.

WATCH

1. A "preventive" resin-based composite procedure can be erroneously reported as a resin-based composite. A posterior composite code is used to describe the restoration of a carious lesion that extends into the dentin and/or where fracture is involved. If the occlusal caries and preparation are limited to the cavitated pits and fissures of a permanent tooth, not extending to the dentin, the restoration is considered a preventative resin restoration (D1352). Pits and fissures adjacent to the PRR that are sealed are considered a part of the D1352 procedure. If the enamel surface is sealed with a resin, and there is no active cavitated lesion in the tooth, the resin is a sealant (D1351). See D1351 and D1352.

2. If two or more separate restorations are performed on the same tooth, on the same service date, report the restorations separately. Reporting separate restorations on the same tooth is not considered unbundling. Always "report what you do but note that some payors may restrict coverage for more than one restoration on the same surface on the same service date.

3. D2391 may be used to report closure of an endodontic access hole through a posterior crown if composite resin is used. See Comment 4 below for more information.

COMMENTS

1. All composite codes include light curing, bonding, acid etching, bases, liners, polishing, and occlusal adjustment in the overall restoration fee.

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. Pins, if placed in a posterior composite restoration, are billed separately. See D2951.

4. Report D2391 when restoring an endodontic access opening of a posterior natural tooth, crown, or the access opening for the internal bleaching (D9974) of a posterior natural tooth with a resin restoration. If performed for endodontic access closure of a crown, state, "An occlusal composite 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. 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. Do not report crown repair necessitated by material failure (D2980) either. If the crown is removed first then core buildup/prefabricated post and core can be reported if the procedure is performed. If a post is placed through an endodontic access opening, report D2999 unspecified restorative procedure.

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

1. The exclusion period for replacement of composite restorations is typically 12 to 36 months; but, if the tooth fractures after the restoration is placed, or if new caries is present, the limitation may not apply. If replacement is necessary, a narrative plus diagnostic image(s) should be submitted when reporting D2391 again for the same tooth. If denied, appeal. A different provider than the one who placed the original restoration may be reimbursed.

2. If a posterior composite restoration has been placed and reimbursed on a tooth that later requires a crown, a limitation may apply (if within a 24 to 36 month period). The previously reimbursed composite restoration fee may be subtracted from the subsequent crown reimbursement fee. If the posterior composite fractures and/or new caries is present, the limitation may not apply. Use a narrative when reporting the need for the crown and include a diagnostic image. A different provider may be fully reimbursed for a subsequent crown.

TIPS

• Sealants (D1351), preventive resin restorations (D1352), and resin-based composite restorations (D2391) differ as follows:

1. Sealant (D1351): Mechanically and/or chemically prepared enamel surface sealed to prevent decay. The enamel surface is non-carious.

2. Preventive Resin Restoration (D1352): Conservative restoration of an active cavitated lesion in a pit or fissure of a permanent tooth which does not extend into the dentin. Also includes placing a sealant in any radiating noncarious pits or fissures. Patient must be moderate to high caries risk.

3. Resin-based composite - one surface, posterior (D2391): This is a posterior resin restoration where the caries and preparation extends into the dentin or a deeply eroded area into the dentin.

4. Report D2990 for resin infiltration of incipient smooth surface lesions (i.e., DMG Icon).

5. Report D2991 for application of hydroxyapatite regeneration medicament (I.e., Curodont Repair).

NARRATIVES

If decay is not clearly visible on the diagnostic image, clinical documentation supporting the need for treatment is strongly recommended in the event of third party review. The clinical record might note: "Caries not evident on diagnostic image; however, was "sticky" to the explorer. Caries and preparation extend into the dentin." Also include any Artificial Intelligence or non-ionizing caries detection results or photo(s) where applicable.