Understanding Dental Code D2652

When to Use D2652 dental code

The D2652 dental code refers to an inlay—specifically, a resin-based composite inlay for a two-surface restoration. This CDT code is used when a patient requires restoration of a tooth that has lost structure due to caries or fracture, but the damage does not warrant a full crown. D2652 is appropriate when the inlay covers two surfaces (typically occlusal and either mesial or distal) and is fabricated outside the mouth, then cemented into place. It is important to distinguish this code from other inlay codes, such as D2650 (one surface), to ensure accurate billing and clinical documentation.

Documentation and Clinical Scenarios

Accurate documentation is essential for successful reimbursement and compliance. When using D2652, dental teams should include:

 
• Detailed clinical notes: Describe the extent of decay or fracture, why a direct restoration (filling) was not suitable, and the rationale for choosing an inlay over a crown.
 
• Pre-operative and post-operative images: Intraoral photos and radiographs that clearly show the tooth’s condition before and after treatment.
 
• Lab prescription and invoice: Attach the laboratory work order and invoice to support that the inlay was fabricated outside the mouth.
 
• Tooth number and surfaces treated: Clearly indicate which tooth and which two surfaces were restored.

Common clinical scenarios for D2652 include moderate caries or fractures on molars or premolars where a conservative, durable restoration is preferred over a full crown.

Insurance Billing Tips

Billing for D2652 requires attention to detail and proactive communication with payers. Here are best practices:

 
• Verify benefits: Before treatment, check the patient’s insurance plan for coverage on inlays. Some plans downgrade inlays to fillings, so inform the patient about potential out-of-pocket costs.
 
• Submit comprehensive documentation: Include clinical notes, radiographs, photos, and lab invoices with the claim. This reduces the risk of denials or requests for additional information.
 
• Use correct CDT codes: Ensure D2652 is not confused with similar codes. If the restoration involves more or fewer surfaces, use the appropriate code.
 
• Appeal denials strategically: If the claim is denied, review the EOB for the reason, gather supporting documentation, and submit a well-organized appeal letter highlighting medical necessity and the inadequacy of direct restorations.

Staying organized and thorough with documentation helps streamline accounts receivable (AR) and minimizes delays in payment.

Example Case for D2652

Case: A patient presents with a fractured distal-occlusal surface on tooth #30. The dentist determines that a direct composite filling would not provide sufficient strength, but a full crown is not yet necessary. The dental team takes pre-op radiographs and intraoral photos, prepares the tooth, and sends an impression to the lab for a two-surface resin inlay. The inlay is cemented at a subsequent appointment. The clinical notes detail the decision-making process, and the lab invoice is attached to the claim. The insurance is verified beforehand, and the patient is informed of possible downgrades. The claim is submitted with all supporting documents, resulting in prompt reimbursement.

This scenario highlights the importance of proper code selection, documentation, and patient communication when billing D2652.