Understanding Dental Code D6792

When to Use D6792 dental code

The D6792 dental code is designated for a "retainer crown – resin with noble metal." This CDT code is used when a retainer crown is fabricated as part of a fixed partial denture (bridge) and constructed with a resin-based material fused to a noble metal substructure. Dental teams should select D6792 when the clinical situation requires a retainer crown that will anchor a bridge, and the chosen materials meet the code’s definition. It is not appropriate for single-unit crowns or for retainer crowns made with high noble or base metals—those have their own specific codes, such as D6791 or D6793.

Documentation and Clinical Scenarios

Accurate documentation is essential for successful claim submission and reimbursement. When using D6792, ensure the patient’s chart clearly indicates:

• The tooth number(s) involved and the edentulous space being restored
• The clinical rationale for choosing a resin with noble metal retainer crown (e.g., esthetic needs, patient allergies, or cost considerations)
• Detailed treatment notes, including pre-op radiographs, intraoral images, and diagnostic models
• The specific materials used in the fabrication process

Common clinical scenarios include replacing a missing tooth with a bridge where the abutment teeth require crowns, and the provider determines that a resin with noble metal is the best restorative option for one or more retainers.

Insurance Billing Tips

Billing D6792 successfully requires attention to detail and proactive communication with payers. Here are best practices:

• Insurance Verification: Before treatment, verify the patient’s benefits for fixed partial dentures and material-specific coverage. Some plans may restrict coverage to certain materials or require pre-authorization for resin-based crowns.
• Pre-Authorization: Submit a pre-treatment estimate with supporting documentation (radiographs, clinical notes, and material details) to minimize claim denials.
• Claim Submission: Clearly indicate the use of code D6792 on the claim form, and attach all required documentation. Specify the tooth numbers and bridge span.
• Explanation of Benefits (EOB) Review: Upon receiving the EOB, review for correct processing. If denied, check for missing documentation or material exclusions.
• Appeals: If a claim is denied, submit an appeal with additional clinical justification and supporting evidence of medical necessity.

Example Case for D6792

Case Study: A 52-year-old patient presents with a missing lower first molar (tooth #30) and adjacent teeth #29 and #31 are healthy but require crowns to support a fixed bridge. The dentist recommends a three-unit bridge with a resin with noble metal retainer crown on #29 and #31. The treatment plan is documented with radiographs, intraoral photos, and a narrative explaining the choice of materials. Insurance verification confirms coverage for D6792. The claim is submitted with all supporting documents, and the practice receives timely reimbursement after EOB review.

This example highlights the importance of thorough documentation, material selection, and proactive insurance communication when using D6792.