Understanding Dental Code D6240

When to Use D6240 dental code

The D6240 dental code is designated for a pontic made of porcelain fused to high noble metal. This CDT code is used when replacing a missing tooth in a fixed bridge, where the pontic serves as the artificial tooth anchored between two crowns. Dental teams should select D6240 when the restorative plan calls for a bridge with a porcelain-fused-to-high-noble-metal pontic, ensuring the material and clinical indication match the code description. Avoid using D6240 for pontics made of base metal, noble metal, or all-ceramic materials—these have their own specific codes.

Documentation and Clinical Scenarios

Accurate documentation is essential for successful reimbursement. When submitting claims for D6240, include detailed clinical notes describing the edentulous space, the teeth involved, and the necessity for a fixed bridge. Radiographs or intraoral photos should clearly show the missing tooth and adjacent abutments. In your charting, specify the material used (porcelain fused to high noble metal) and the location of the pontic. Common clinical scenarios include patients missing a single tooth with healthy abutment teeth on either side, or replacing multiple teeth with a multi-unit bridge. Always document the patient's restorative needs and why a removable prosthesis is not appropriate.

Insurance Billing Tips

Maximizing reimbursement for D6240 requires careful attention to insurance verification and claim submission. Start by verifying the patient’s benefits for fixed bridges and high noble metal coverage—some plans downgrade to base metal or exclude certain materials. Submit a pre-authorization with supporting documentation, including diagnostic images and a narrative explaining the clinical necessity. When billing, ensure the claim form accurately lists D6240 and includes all required attachments. Review the Explanation of Benefits (EOB) for downgrades or denials, and be prepared to submit a claim appeal with additional documentation if needed. Track claims in your accounts receivable (AR) workflow and follow up promptly on outstanding balances.

Example Case for D6240

Consider a patient missing tooth #19, with healthy abutments at #18 and #20. The treatment plan calls for a three-unit bridge with a porcelain-fused-to-high-noble-metal pontic. The dental team documents the edentulous space, takes pre-op radiographs, and notes the patient’s preference for a fixed solution over a removable partial denture. Insurance is verified, confirming coverage for high noble metal. A pre-authorization is submitted and approved. After treatment, the claim is filed with D6240 for the pontic, and related codes for the abutment crowns. The EOB is reviewed, and payment is posted. If the insurance carrier downgrades to a base metal allowance, the office provides a clear explanation to the patient and collects the difference per the financial policy.