Understanding Dental Code D2931

When to Use D2931 dental code

The D2931 dental code is designated for a prefabricated stainless steel crown—permanent tooth. This CDT code is most commonly used in pediatric dentistry but can also apply to adult patients when a permanent tooth requires a durable, interim restoration. D2931 is appropriate when a tooth has extensive caries, developmental defects, or after pulpotomy/pulpectomy, and a full-coverage restoration is necessary but a custom crown is not yet indicated. Stainless steel crowns are typically used on posterior teeth due to their strength and cost-effectiveness.

Documentation and Clinical Scenarios

Accurate documentation is essential for successful claim submission and reimbursement. Clinical notes should clearly indicate:

• The tooth number and surfaces affected
• The diagnosis (e.g., caries, fracture, developmental anomaly)
• Why a prefabricated crown was chosen over other restorative options
• Details of any prior procedures, such as pulpotomy or pulpectomy
• Pre- and post-operative radiographs, if available

Common clinical scenarios for D2931 include a child’s first permanent molar with extensive decay, or an adult molar with a temporary need for full coverage due to financial or clinical considerations. Always ensure the rationale for using a stainless steel crown is well-supported in the patient record.

Insurance Billing Tips

To maximize reimbursement and minimize denials when billing D2931:

• Verify benefits before treatment to confirm coverage for stainless steel crowns on permanent teeth, as some plans restrict this benefit to primary teeth (D2930).
• Submit detailed narratives with claims, explaining the clinical necessity and why alternative treatments were not suitable.
• Attach supporting documentation such as intraoral photos and radiographs to demonstrate the extent of decay or damage.
• Review the Explanation of Benefits (EOB) carefully. If denied, check for plan limitations or missing documentation, and submit a claim appeal with additional details if needed.
• Track claims in your accounts receivable (AR) workflow to ensure timely follow-up and resolution.

Staying proactive with insurance verification and thorough documentation are key to successful D2931 billing.

Example Case for D2931

Case: A 9-year-old patient presents with extensive caries on the mandibular first permanent molar (#19). After caries removal and pulpotomy, the tooth structure is insufficient for a direct restoration. The provider places a prefabricated stainless steel crown for full coverage and durability.

Best Practice Steps:

1. Document the diagnosis, procedure, and rationale for crown selection in the clinical notes.
2. Take pre- and post-op radiographs and intraoral photos.
3. Verify insurance coverage for D2931 prior to treatment.
4. Submit the claim with a detailed narrative and all supporting documentation.
5. Monitor the claim status and respond promptly to any requests for additional information or appeals.

This process ensures clear communication with payers and supports optimal reimbursement for the dental practice.