Understanding Dental Code D2791

When to Use D2791 dental code

The D2791 dental code is designated for a full cast high noble metal crown. This CDT code should be used when a tooth requires full coverage due to extensive decay, fracture, or structural compromise that cannot be restored with a direct filling. High noble metal crowns are known for their durability and biocompatibility, making them a preferred choice for posterior teeth where strength is critical. Use D2791 only when the crown is fabricated with a high noble alloy, as defined by the American Dental Association (ADA) standards.

Documentation and Clinical Scenarios

Accurate documentation is essential for successful claim submission and reimbursement. When billing for D2791, ensure the patient record includes:

• Detailed clinical notes describing the extent of decay, fracture, or previous restoration failure.
• Pre-operative radiographs showing the tooth’s condition.
• Intraoral photographs, if available, to support the need for a full coverage crown.
• Charting of existing restorations and any failed previous treatments.

Common clinical scenarios for D2791 include teeth with large, failing amalgam or composite restorations, endodontically treated teeth requiring reinforcement, or teeth with significant structural loss due to caries or trauma.

Insurance Billing Tips

To maximize reimbursement and minimize denials for D2791 claims, follow these best practices:

• Insurance Verification: Confirm the patient’s coverage for crowns, frequency limitations, and replacement clauses before treatment.
• Pre-authorization: Submit a pre-treatment estimate with supporting documentation to the payer, especially for high-value procedures like D2791.
• Claim Submission: Attach all required documentation (clinical notes, radiographs, photos) to the initial claim. Clearly indicate the use of high noble metal in the lab prescription and invoice.
• Explanation of Benefits (EOB) Review: Carefully review EOBs for denial reasons. If denied, file a timely claim appeal with additional documentation or clarification as needed.
• Alternate Codes: If the crown is fabricated from a different material, consider whether codes like D2750 (porcelain fused to high noble metal) or D2792 (full cast noble metal) are more appropriate.

Example Case for D2791

Consider a 52-year-old patient presenting with a fractured lower molar previously restored with a large amalgam filling. Clinical examination and radiographs reveal insufficient remaining tooth structure to support another direct restoration. After discussing options, the dentist recommends a full cast high noble metal crown. The dental team verifies insurance coverage, submits a pre-authorization with supporting images and notes, and receives approval. The crown is fabricated and delivered, and the claim is submitted with all required documentation. The insurance pays according to plan benefits, and the patient’s account is reconciled efficiently, demonstrating a best-practice workflow for D2791 billing.