Understanding Dental Code D2390

When to Use D2390 dental code

The D2390 dental code is designated for a resin-based composite crown, anterior. This CDT code is specifically used when a full-coverage, direct composite crown is placed on an anterior (front) tooth. Unlike other composite codes that cover fillings or partial restorations, D2390 is reserved for situations where the entire clinical crown requires restoration due to extensive decay, fracture, or previous restoration failure. It is important to note that D2390 should not be used for posterior teeth or for veneers, as there are separate codes for those procedures.

Documentation and Clinical Scenarios

Accurate documentation is crucial when billing D2390. The clinical notes should clearly indicate:

• The extent of tooth structure loss (e.g., due to caries, trauma, or failed restoration)
• Why a full-coverage restoration is necessary instead of a conventional filling
• Pre-operative and post-operative photographs or radiographs, if possible
• Details of the materials used and the steps taken to restore the tooth

Common clinical scenarios include:

• A child or adolescent with a fractured anterior tooth where a crown is needed but a traditional lab-fabricated crown is not appropriate
• Patients seeking a cost-effective, same-day solution for significant anterior tooth damage
• Cases where a full-coverage restoration is required, but the patient is not a candidate for porcelain or metal crowns

Insurance Billing Tips

To maximize reimbursement and minimize denials for D2390, dental offices should follow these best practices:

• Verify coverage: Before treatment, verify the patient’s insurance plan for coverage of resin-based composite crowns on anterior teeth. Some plans may restrict coverage to certain age groups or clinical situations.
• Submit comprehensive documentation: Include detailed clinical notes, pre- and post-op images, and a narrative explaining why a full-coverage restoration was necessary. This supports medical necessity and helps prevent claim denials.
• Use correct CDT code: Ensure D2390 is only used for direct, full-coverage composite crowns on anterior teeth. For multi-surface fillings, consider codes like D2330 or D2332.
• Appeal denials effectively: If a claim is denied, review the Explanation of Benefits (EOB) for the reason and submit an appeal with additional documentation, such as intraoral photos or a more detailed narrative.

Example Case for D2390

Case: A 16-year-old patient presents with a fractured maxillary central incisor (#9) due to a sports injury. The fracture involves most of the clinical crown, but the root is intact and healthy. After discussing options, the dentist and patient’s guardian agree on a direct resin-based composite crown for immediate restoration.

Billing steps:

1. Verify insurance benefits for D2390 and obtain pre-authorization if required.
2. Document the extent of the fracture with photos and a detailed narrative.
3. Complete the restoration and document the procedure, including materials used.
4. Submit the claim with D2390, attaching all supporting documentation.
5. If the claim is denied, review the EOB and submit an appeal with additional clinical justification.

This approach ensures the claim is well-supported and increases the likelihood of timely reimbursement.