Understanding Dental Code D2790

When to Use D2790 dental code

The D2790 dental code is used to report the placement of a full cast high noble metal crown. This CDT code is appropriate when a tooth requires complete coverage due to extensive decay, fracture, or after endodontic treatment, and when a high noble metal (such as gold or platinum alloys) is chosen for its durability and biocompatibility. Use D2790 only when the clinical situation meets these criteria and the crown is fabricated entirely from high noble metal, not porcelain-fused or base metal alternatives. Proper code selection is essential for accurate reimbursement and compliance with insurance policies.

Documentation and Clinical Scenarios

Accurate documentation is crucial when billing D2790. Dental offices should ensure that the patient’s chart includes:

• Detailed clinical notes describing the extent of decay, fracture, or structural loss
• Pre-operative radiographs showing the condition of the tooth
• Intraoral photographs (if available) for visual evidence
• Material selection notes specifying the use of high noble metal

Common clinical scenarios include:

• A molar with extensive caries undermining cuspal structure
• A previously root canal-treated tooth requiring full coverage
• Replacement of an existing high noble metal crown due to wear or recurrent decay

Thorough documentation supports the medical necessity of the procedure and helps prevent claim denials.

Insurance Billing Tips

To maximize reimbursement and minimize delays when billing D2790:

1. Verify coverage: Before treatment, confirm the patient’s plan covers high noble metal crowns and check for frequency limitations or replacement clauses.
2. Submit supporting documentation: Always include clinical notes, radiographs, and photos with the claim. Clearly indicate the use of high noble metal in your narrative.
3. Use accurate CDT codes: Do not substitute D2790 for other crown types, such as porcelain-fused-to-metal crowns or full cast noble metal crowns. Each code has specific criteria.
4. Monitor EOBs: Review Explanation of Benefits statements for underpayments or denials. If the claim is denied, review the insurer’s reason code and prepare an appeal with additional documentation if necessary.
5. Track AR: Stay on top of accounts receivable by following up on outstanding claims within 30 days of submission.

Proactive communication with payers and detailed documentation are key to successful claim processing.

Example Case for D2790

Case: A 55-year-old patient presents with a fractured upper right first molar (tooth #3) with a history of root canal therapy. Clinical evaluation and radiographs confirm that the remaining tooth structure is insufficient for a direct restoration. The dentist recommends a full cast high noble metal crown for optimal strength and longevity.

Billing workflow:

• Insurance verification confirms coverage for D2790 with a five-year replacement clause.
• Pre-op radiographs and intraoral photos are taken and attached to the claim.
• Clinical notes detail the fracture and rationale for high noble metal selection.
• The claim is submitted with D2790, supporting documentation, and a clear narrative.
• The EOB is reviewed upon receipt. If additional information is requested, the office promptly responds with the required documentation.

This step-by-step approach ensures a higher likelihood of claim approval and timely payment.