Understanding Dental Code D6214

When to Use D6214 dental code

The D6214 dental code refers to a pontic made of titanium and titanium alloys, typically used in fixed partial dentures (bridges) to replace a missing tooth. This code is specific to the material and is distinct from other pontic codes, such as those for porcelain or high noble metal. Use D6214 when a titanium pontic is fabricated and placed as part of a fixed bridge, ensuring the material matches the CDT descriptor. This code is not appropriate for removable prosthetics or for pontics made of other metals or ceramics.

Documentation and Clinical Scenarios

Accurate documentation is crucial for successful reimbursement. Clinical notes should clearly indicate:

• The edentulous space (missing tooth location)
• The need for a fixed bridge and the choice of titanium due to patient-specific factors (e.g., allergies, strength requirements)
• Pre-operative and post-operative radiographs
• Detailed charting of the abutment teeth and pontic site
• Laboratory prescriptions specifying titanium material

Common clinical scenarios for D6214 include patients with metal allergies, those requiring high strength with biocompatibility, or cases where titanium is preferred for long-term durability. Always ensure that the clinical rationale for choosing titanium is well documented in the patient record.

Insurance Billing Tips

Billing for D6214 requires attention to detail to avoid denials and delays. Here are actionable steps for successful claims:

1. Verify coverage: Before treatment, check the patient’s insurance plan for bridge and material-specific coverage. Not all plans cover titanium pontics.
2. Pre-authorization: Submit a pre-authorization with supporting documentation, including radiographs and clinical notes explaining the choice of titanium.
3. Accurate coding: Use D6214 only when the pontic is made of titanium/titanium alloys. For other materials, reference the appropriate code, such as D6205 for porcelain/ceramic pontics.
4. Attach supporting documents: Include lab invoices, photos, and narratives with the claim to support medical necessity.
5. Track EOBs: Review Explanation of Benefits (EOBs) for payment accuracy and note any downgrades or denials for appeal.
6. Appeal if needed: If denied, submit a claim appeal with additional documentation, emphasizing the clinical need for titanium.

Example Case for D6214

Consider a patient missing tooth #19 with a history of nickel allergy. After discussing options, the dentist recommends a fixed bridge with a titanium pontic for biocompatibility. The office documents the allergy, takes diagnostic radiographs, and submits a pre-authorization with a narrative. Upon approval, the lab fabricates a titanium pontic. The claim is submitted with D6214, lab invoice, and clinical notes. The insurance pays according to the plan, and the office posts the payment, reconciling the AR. This workflow ensures compliance and maximizes reimbursement.