Understanding Dental Code D2990

The D2990 dental code, officially titled “Resin infiltration of incipient smooth surface lesions”, is a valuable addition to the CDT code set for minimally invasive caries management. Proper understanding and use of D2990 can help dental practices provide optimal patient care while ensuring accurate insurance reimbursement. This guide breaks down when and how to use D2990, what documentation is required, billing best practices, and a practical example to help your team master this code.

When to Use D2990 dental code

D2990 is used for resin infiltration of early, non-cavitated carious lesions (incipient lesions) on smooth tooth surfaces, typically enamel. This procedure is indicated when a carious lesion is visible on radiographs or clinically, but has not yet progressed to a full cavity. The goal is to halt lesion progression without drilling or placing a traditional restoration.

Key criteria for using D2990:

• Lesion is confined to enamel or outer third of dentin.
• No cavitation or loss of tooth structure.
• Lesion is on a smooth surface (not occlusal or pit/fissure).
• Resin infiltration is performed to arrest caries progression.

Do not use D2990 for lesions requiring traditional fillings (see anterior composite restorations) or for preventive sealants (sealant code D1351).

Documentation and Clinical Scenarios

Accurate documentation is essential for claim approval and compliance. Best practices include:

• Chart notes: Clearly describe the tooth/teeth treated, lesion location, and rationale for resin infiltration.
• Radiographs or photos: Attach diagnostic images showing incipient lesion(s) before treatment.
• Procedure details: Note the materials used, steps taken, and patient consent.
• Outcome: Document the expected benefit (arrested lesion, no cavitation).

Common clinical scenarios include white spot lesions after orthodontic treatment, early smooth surface caries in pediatric or adult patients, and situations where traditional restoration is not yet indicated.

Insurance Billing Tips

Insurance coverage for D2990 dental code varies widely. Here are actionable steps to maximize reimbursement:

• Insurance verification: Before treatment, verify if the patient’s plan covers D2990. Many plans consider it a preventive or adjunctive service.
• Pre-authorization: Submit a pre-treatment estimate with supporting documentation (radiographs, chart notes) to reduce denial risk.
• Claim submission: Use the correct CDT code (D2990) and include all supporting documents. Clearly state the medical necessity in the narrative.
• Appeals: If denied, file a claim appeal with additional clinical justification and literature supporting resin infiltration efficacy.
• Patient communication: Inform patients about possible out-of-pocket costs if insurance does not cover D2990.

Stay updated on payer policies, as coverage for minimally invasive caries treatments is evolving.

Example Case for D2990

Case: A 15-year-old patient presents with white spot lesions on the buccal surfaces of upper anterior teeth following orthodontic treatment. Radiographs confirm incipient enamel lesions without cavitation.

Steps:

1. Obtain insurance verification and pre-authorization for D2990.
2. Document clinical findings and capture diagnostic photos.
3. Perform resin infiltration procedure as per manufacturer instructions.
4. Submit claim with detailed narrative and images.
5. Follow up on claim status and appeal if necessary.

This approach demonstrates clinical appropriateness, thorough documentation, and proactive billing—key to successful reimbursement for D2990.