Understanding Dental Code D6722

When to Use D6722 dental code

The D6722 dental code is designated for a retainer crown—specifically, a pontic retainer crown for a fixed partial denture (FPD) made of cast noble metal. This code is used when a patient requires a retainer crown as part of a bridge, where the crown serves to anchor the prosthesis to an abutment tooth. It is essential to differentiate D6722 from other retainer crown codes, such as D6750 (porcelain fused to high noble metal), by confirming the specific material and function of the crown within the bridge structure.

Documentation and Clinical Scenarios

Proper documentation is critical for successful claim submission and reimbursement. When using D6722, ensure the patient’s chart includes:

• Detailed clinical notes describing the need for a fixed partial denture and the abutment tooth’s condition.
• Radiographs or intraoral images supporting the necessity of the retainer crown.
• Material specification—confirming the use of cast noble metal for the retainer crown.
• Pre-operative and post-operative documentation, including shade selection and lab slips.

Common clinical scenarios for D6722 include cases where a patient is missing one or more teeth and requires a bridge, with abutment teeth strong enough to support a cast noble metal retainer crown. Always document any failed previous restorations or recurrent decay that necessitated the bridgework.

Insurance Billing Tips

Accurate billing for D6722 can help minimize denials and delays in accounts receivable (AR). Follow these best practices:

• Insurance Verification: Confirm the patient’s benefits for fixed partial dentures and specific coverage for cast noble metal crowns before treatment.
• Pre-authorization: Submit a pre-treatment estimate with supporting documentation and radiographs to the insurance carrier.
• Claim Submission: Use the correct CDT code (D6722) and include all required attachments—clinical notes, images, and lab invoices.
• EOB Review: Carefully review the explanation of benefits (EOB) for any downgrades or denials. If denied, initiate a claim appeal with additional documentation and a narrative explaining medical necessity.

Stay updated on annual maximums, frequency limitations, and replacement clauses, as these can impact reimbursement for D6722. If the insurance plan downgrades to a less expensive material, inform the patient of their financial responsibility.

Example Case for D6722

Consider a 52-year-old patient missing tooth #19, with teeth #18 and #20 as potential abutments. After clinical evaluation and radiographs, the dentist determines that a three-unit bridge with cast noble metal retainer crowns on #18 and #20 is the best solution. The dental team documents the treatment plan, obtains pre-authorization, and submits a claim using D6722 for each retainer crown. The insurance carrier requests additional radiographs, which are promptly provided. The claim is approved, and the patient receives the bridge with proper reimbursement for the D6722-coded crowns.

This scenario highlights the importance of thorough documentation, proactive insurance communication, and correct code usage to ensure timely payment and patient satisfaction.