Understanding Dental Code D6251

When to Use D6251 dental code

The D6251 dental code is used to describe a pontic made of resin with a predominantly base metal. This CDT code applies specifically to fixed partial dentures (bridges) where the artificial tooth (pontic) is fabricated from resin material fused to a base metal substructure. Dental teams should select D6251 when restoring an edentulous space using a bridge, and the chosen material combination is resin and base metal, rather than all-ceramic, all-metal, or porcelain-fused-to-metal alternatives. Proper code selection ensures accurate claim submission and reimbursement.

Documentation and Clinical Scenarios

Accurate documentation is essential for successful billing and compliance. When using D6251, include detailed clinical notes describing:

• The edentulous area being restored (tooth numbers involved)
• The material used for the pontic (resin with base metal)
• Pre-operative and post-operative radiographs or intraoral images
• Patient’s restorative needs and rationale for material choice

Common clinical scenarios for D6251 include patients requiring a cost-effective bridge solution or those with specific material allergies. Always document any medical necessity or patient-specific considerations that influenced the choice of a resin-based pontic.

Insurance Billing Tips

To maximize reimbursement and minimize denials when billing D6251:

• Verify coverage: Confirm the patient’s insurance benefits for fixed partial dentures and specifically for resin-based pontics during the insurance verification process.
• Submit supporting documentation: Attach clinical notes, radiographs, and a narrative explaining the need for the pontic and material selection.
• Use correct CDT codes: Ensure D6251 is used only for resin with base metal pontics. For other materials, reference the appropriate CDT code, such as D6240 for porcelain fused to high noble metal.
• Review EOBs promptly: Analyze Explanation of Benefits statements for payment accuracy and denial reasons. If denied, prepare a claim appeal with additional documentation as needed.

Successful dental offices establish a workflow for pre-authorizations, timely claims submission, and proactive AR (accounts receivable) follow-up to ensure prompt payment for D6251 procedures.

Example Case for D6251

Case Study: A 56-year-old patient presents with a missing lower first molar. After discussing restorative options, the dentist recommends a three-unit bridge with a resin-based pontic due to the patient’s budget and mild metal sensitivity. The dental team documents the edentulous space, material selection rationale, and pre-op radiographs. Insurance verification confirms coverage for D6251. The claim is submitted with all supporting documents, and payment is received without delay. This case highlights the importance of thorough documentation, correct code selection, and proactive insurance communication when billing for D6251.