D2392

• RESIN-BASED COMPOSITE - TWO SURFACES, POSTERIOR

WARNING

It is misleading to report composite restorations as core buildup (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 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 preventive resin restoration (D1352). Pits and fissures adjacent to the PRR that are sealed are considered a part of D1352. If the enamel surface is sealed with a resin, and there is no 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.

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

LIMITATIONS

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 D2392 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 recurrent 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.

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.