Understanding Dental Code D6210

When to Use D6210 dental code

The D6210 dental code refers to a pontic, specifically a cast high noble metal pontic used in fixed partial dentures (bridges). Dental teams should use D6210 when billing for the replacement tooth portion of a bridge that is fabricated from high noble metal alloys. This code is appropriate only when the pontic is not an implant-supported restoration and must be differentiated from other pontic codes, such as those for base metal or porcelain-fused-to-metal options. Accurate code selection ensures proper reimbursement and compliance with CDT guidelines.

Documentation and Clinical Scenarios

Proper documentation is essential for successful claims. When using D6210, include detailed clinical notes describing the edentulous space, the teeth being replaced, and the materials used. Radiographs or intraoral photos should clearly show the missing tooth and adjacent abutments. Common clinical scenarios include patients missing a single tooth or multiple teeth where a fixed bridge is the treatment of choice, and the pontic is fabricated from high noble metal. Always document the patient’s restorative needs, material selection rationale, and pre-op/post-op images to support the claim.

Insurance Billing Tips

To maximize reimbursement and minimize denials for D6210, follow these best practices:

• Insurance Verification: Confirm the patient’s bridge benefits, frequency limitations, and material coverage before treatment. Some plans restrict high noble metal usage or require pre-authorization.
• Pre-Authorization: Submit a pre-treatment estimate with supporting documentation (radiographs, narrative, material choice) to avoid surprises.
• Claim Submission: Clearly indicate D6210 on the claim form, attach all required documentation, and specify the tooth numbers involved. Use precise narratives explaining why high noble metal was chosen.
• Handling EOBs and Appeals: If the claim is denied, review the Explanation of Benefits (EOB) for denial reasons. Submit a detailed appeal with additional documentation, emphasizing clinical necessity and material selection.

Example Case for D6210

Consider a patient missing tooth #19. After evaluation, the dentist recommends a three-unit bridge with a cast high noble metal pontic. The treatment plan is discussed, and insurance verification confirms coverage for high noble metal. The office submits a pre-authorization with radiographs and a narrative. After approval, the bridge is fabricated and delivered. The claim is submitted with D6210 for the pontic, along with supporting documentation. The insurance pays according to plan benefits, and the patient’s account is reconciled efficiently. This real-world workflow highlights the importance of thorough documentation and proactive insurance communication.