Understanding Dental Code D6085

When to Use D6085 dental code

The D6085 dental code is designated for a provisional implant crown—a temporary crown placed on an implant abutment during the healing or integration phase before the final prosthesis is delivered. This code is used when a patient requires an interim restoration to maintain esthetics, function, or tissue contour while awaiting the definitive implant crown. It is important to note that D6085 should not be used for provisional crowns on natural teeth or for long-term temporaries intended as final restorations.

Documentation and Clinical Scenarios

Proper documentation is essential when submitting claims for D6085. Clinical notes should clearly indicate:

• The implant site and date of placement
• The reason for the provisional crown (e.g., tissue shaping, esthetics, function)
• The expected timeline for the final implant crown
• Photos or radiographs supporting the need for the provisional

Common clinical scenarios include anterior implant cases where immediate esthetics are a concern, or when soft tissue needs to be molded before the final restoration. Always distinguish between a true provisional and a final implant-supported crown (implant crown code), as payers may request additional information to justify the use of D6085.

Insurance Billing Tips

Billing for D6085 requires attention to payer policies, as coverage for provisional implant crowns varies widely. Here are best practices for successful claim submission:

• Verify coverage before treatment by contacting the patient’s dental plan and documenting the response in the patient record.
• Submit detailed narratives with the claim, explaining the clinical necessity for the provisional crown and referencing the implant placement date.
• Include supporting documentation such as pre-op photos, radiographs, and a treatment timeline.
• Be prepared for claim denials; many plans consider D6085 a non-covered or inclusive service. If denied, review the EOB and, if appropriate, submit a claim appeal with additional documentation.
• Track all claims in your accounts receivable (AR) system and follow up promptly on outstanding or denied claims.

Clear communication with patients about their financial responsibility is also critical, especially if insurance coverage is unlikely.

Example Case for D6085

Consider a patient who receives an implant in the upper central incisor area. Due to esthetic demands and the need to sculpt the gingival tissue, the dentist places a provisional implant crown immediately after uncovering the implant. The clinical notes specify the implant site, healing status, and rationale for the provisional. The office submits a claim using D6085, attaches pre- and post-op photos, and includes a narrative detailing the need for tissue contouring. The insurance plan initially denies the claim, but after submitting an appeal with additional documentation, the claim is approved. This scenario highlights the importance of thorough documentation and proactive claim management when billing for D6085.