Understanding Dental Code D2980

When to Use D2980 dental code

The D2980 dental code is designated for the repair of a crown when the restoration is required due to the failure of the restorative material, not because of recurrent decay or trauma. This CDT code is specifically used when an existing crown—whether full coverage or partial—remains intact but has experienced chipping, fracture, or loss of restorative material that can be repaired without replacing the entire crown. Dental teams should use D2980 only when the repair is clinically justified, and the crown’s underlying structure is sound.

Documentation and Clinical Scenarios

Proper documentation is essential for successful reimbursement when billing D2980. Dental practices should include detailed clinical notes describing the nature and extent of the crown’s material failure, supported by intraoral photographs and radiographs if available. Common clinical scenarios include:

• Fractured porcelain on a porcelain-fused-to-metal crown with the metal substructure intact
• Loss of composite or ceramic facing on an anterior crown
• Chipped ceramic on a zirconia crown that can be repaired intraorally

Always record the original placement date of the crown and specify the materials used. This information helps insurance payers determine coverage eligibility and prevents unnecessary claim denials.

Insurance Billing Tips

To maximize reimbursement and minimize delays, follow these best practices when billing D2980:

• Verify coverage: Not all dental plans cover crown repairs, so confirm benefits during insurance verification and document the patient’s eligibility.
• Submit supporting documentation: Attach clinical notes, before-and-after photos, and radiographs to the claim. Clearly indicate why a repair (not replacement) is clinically appropriate.
• Use accurate narratives: Provide a concise narrative explaining the restorative material failure and the repair procedure performed.
• Appeal denials: If a claim is denied, review the EOB for the denial reason, gather additional documentation, and submit a thorough appeal letter referencing the specific clinical circumstances.
• Know related codes: If the crown must be replaced due to decay or structural failure, consider using full crown replacement codes instead.

Example Case for D2980

A patient presents with a chipped porcelain margin on a three-year-old PFM crown on tooth #8. The crown’s metal substructure is intact, and there is no evidence of decay or underlying tooth fracture. The dentist repairs the porcelain using a bonded composite material. The clinical notes include the date of original crown placement, detailed photos of the defect and repair, and a narrative describing the need for repair due to material failure. The claim is submitted with code D2980, all supporting documentation, and a clear explanation, leading to successful reimbursement.