Understanding Dental Code D6242

When to Use D6242 dental code

The D6242 dental code refers to a pontic made of porcelain fused to noble metal. This CDT code is used when a dentist provides a replacement tooth (pontic) as part of a fixed partial denture (bridge) where the pontic is fabricated from porcelain fused to a precious metal alloy. D6242 should be selected when the clinical situation requires a durable, esthetic solution for a missing tooth, and the materials specified meet the code’s requirements. It’s important to confirm that the alloy used qualifies as "noble metal" according to ADA guidelines, which typically means it contains at least 25% precious metals such as gold, palladium, or platinum.

Documentation and Clinical Scenarios

Accurate documentation is essential for successful billing of D6242. Clinical notes should clearly indicate:

• The tooth number(s) being replaced
• The material used for the pontic (porcelain fused to noble metal)
• The reason for tooth loss (e.g., extraction, trauma, congenital absence)
• Pre-operative and post-operative radiographs or intraoral photos
• Details of the treatment plan, including abutment teeth and adjacent structures

Common scenarios for D6242 include replacing a single missing tooth between two healthy abutments or as part of a multi-unit bridge. For other types of pontics, such as those made of all-ceramic or base metal, use the appropriate CDT codes, such as D6245 or D6240.

Insurance Billing Tips

To maximize reimbursement and minimize denials for D6242, follow these best practices:

• Verify patient benefits before treatment to confirm bridge coverage, frequency limitations, and replacement clauses.
• Submit detailed narratives with claims, explaining the clinical necessity and material used.
• Attach diagnostic images (radiographs, photos) and chart notes to support the claim.
• Use accurate CDT codes for all components of the bridge, including abutments and other pontics.
• Review EOBs (Explanation of Benefits) carefully for denial reasons and be prepared to submit appeals with additional documentation if needed.

Staying current with payer policies and maintaining clear communication with patients about their financial responsibilities will help streamline the revenue cycle and reduce accounts receivable (AR) delays.

Example Case for D6242

Consider a patient missing tooth #19, with healthy abutment teeth #18 and #20. The dentist recommends a three-unit fixed bridge, with a D6242 pontic (porcelain fused to noble metal) replacing #19 and D6752 crowns on the abutments. The treatment plan, radiographs, and pre-op photos are documented in the patient record. Before starting, the office verifies insurance coverage for bridges and confirms the patient’s eligibility. When submitting the claim, the office includes a narrative describing the missing tooth, the materials used, and attaches supporting images. The claim is approved, and the EOB confirms payment for the D6242 pontic as billed.

This step-by-step approach ensures compliance, reduces claim denials, and supports optimal patient care and practice revenue.