Understanding Dental Code D2982

When to Use D2982 dental code

The D2982 dental code is designated for the repair of an onlay when the repair is necessitated by the failure of the restorative material, not due to recurrent decay or fracture of the tooth structure itself. This code is used when an existing onlay—whether composite or metal—shows signs of breakdown, such as chipping, marginal leakage, or partial loss, and a repair is clinically indicated rather than a full replacement. Proper use of D2982 ensures that the dental office is accurately reimbursed for the time and materials involved in restoring the integrity of the onlay, while also supporting conservative patient care.

Documentation and Clinical Scenarios

Accurate documentation is critical when billing D2982. The clinical notes should clearly describe the condition of the existing onlay, the nature of the restorative material failure (e.g., marginal breakdown, chipping, or partial loss of material), and the specific repair performed. Intraoral photographs and radiographs can provide additional evidence to support the necessity of the repair. Common clinical scenarios include:

• A patient presents with a chipped composite onlay, but the underlying tooth structure is intact.
• Marginal leakage is detected around a metal onlay, and the dentist repairs the margin with composite material.
• Portion of the onlay material has fractured off, but the remainder is stable and functional.

In all cases, the documentation should differentiate between restorative material failure (appropriate for D2982) and failures due to caries or tooth fracture (which may require a different code, such as D2980 for crown repair).

Insurance Billing Tips

To maximize claim acceptance for D2982, follow these best practices:

• Pre-authorization: When possible, submit a pre-authorization with supporting documentation, including clinical notes and images.
• Detailed narratives: Provide a concise narrative on the claim form explaining why the repair was needed and confirming that the failure was limited to the restorative material.
• Attach supporting evidence: Include intraoral photos, radiographs, and any other relevant documentation to demonstrate the condition of the onlay before and after repair.
• Review EOBs: Carefully review Explanation of Benefits (EOBs) for denials or requests for additional information, and be prepared to submit claim appeals with further documentation if needed.
• Verify coverage: Not all dental plans cover onlay repairs. Always verify benefits during insurance verification and communicate potential out-of-pocket costs to the patient.

Example Case for D2982

Consider a patient who returns for a recall visit, and the dentist notes that a previously placed ceramic onlay on tooth #14 has a small chip at the margin, but the tooth is otherwise healthy and the onlay is stable. The dentist smooths the area and repairs the chip with composite resin. The clinical notes document the location and extent of the chip, the absence of caries or tooth fracture, and the materials used for repair. The claim is submitted with D2982, accompanied by before-and-after photos and a narrative stating, "Repair of ceramic onlay on #14 due to marginal chipping of restorative material; no recurrent decay or fracture present." This thorough approach increases the likelihood of claim approval and ensures accurate reimbursement.