Understanding Dental Code D2794

When to Use D2794 dental code

The D2794 dental code is used to report the placement of a crown—specifically, a crown made of high noble metal. This CDT code applies when a tooth requires full coverage due to extensive decay, fracture, or after root canal therapy, and the restoration must be fabricated from high noble metal for optimal strength and longevity. It is important to verify that the material used meets the ADA’s definition of high noble metal, which typically contains at least 60% noble metal, with at least 40% gold.

Documentation and Clinical Scenarios

Proper documentation is essential for successful reimbursement when billing D2794. Clinical notes should clearly indicate:

• The diagnosis justifying the need for a full-coverage crown (e.g., large carious lesion, fractured cusp, or post-endodontic treatment).
• Why a high noble metal crown is the material of choice (e.g., patient’s occlusal forces, allergies to other materials, or specific clinical requirements).
• Pre-operative radiographs and intraoral photographs supporting the necessity of the crown.
• Detailed chart entries describing the preparation, impression, and cementation process.

Common clinical scenarios include molars with significant structural loss, patients with parafunctional habits (such as bruxism), or cases where biocompatibility is a concern.

Insurance Billing Tips

To maximize claim acceptance and minimize delays, follow these best practices:

• Insurance Verification: Confirm the patient’s coverage for crowns, frequency limitations, and material restrictions before treatment. Some plans may downgrade benefits to a less expensive material, so discuss potential out-of-pocket costs with the patient.
• Claim Submission: Submit a detailed claim with the D2794 code, supporting documentation, and clear clinical justification. Attach pre-op x-rays, intraoral images, and a narrative explaining why a high noble metal crown is necessary.
• Explanation of Benefits (EOB) Review: Carefully review EOBs for downgrades or denials. If a claim is denied due to material choice, reference the clinical notes and appeal with additional documentation as needed.
• Accounts Receivable (AR) Follow-up: Track outstanding claims and follow up promptly with payers. Use a systematic approach to appeals, including resubmitting claims with enhanced narratives and documentation.

Example Case for D2794

Consider a 55-year-old patient presenting with a fractured upper first molar following root canal therapy. The clinical team determines that a high noble metal crown is indicated due to the patient’s heavy bite and history of metal allergies. The dental office documents the diagnosis, captures pre-op radiographs, and explains the material choice in the chart. The claim is submitted with the D2794 code, supporting images, and a narrative. The insurance initially downgrades the benefit, but after an appeal with additional documentation, the claim is approved at the high noble metal crown rate.

By following these steps and maintaining thorough documentation, dental teams can ensure accurate billing and optimal reimbursement for procedures reported under D2794.