The American Dental Association’s Current Dental Terminology (CDT) notes that a core buildup, including any pins when required (D2950), “Refers to building up of coronal structure when there is insufficient retention for a separate extracoronal restorative procedure. A core buildup is not a filler to eliminate any undercut, box form, or concave irregularity in a preparation.”
The goal of a buildup is to obtain sufficient height and width in order to support an extracoronal restoration, i.e. a crown. For purposes of coverage, “sufficient” means that there has to be extensive loss of tooth structure from caries or tooth fracture, and there is not enough tooth strength and/or retention to support a crown and prevent dislodgement. Specifically, this means:
- 50% or more of tooth structure is carious or fractured;
- The preparation is below the gingival crest; and
- There is less than 3 mm of sound dentin vertically above the preparation line in opposing walls where the crown's margin will be located.
Consistent with the ADA definition, a buildup will not be approved when the procedure only involves a filler to eliminate any undercut, box for or irregularity in the preparation, or if it does not meet the criteria noted above. As an example, an occlusal or lingual restoration to fill an endodontic access prep, does not qualify as a buildup. Additionally, if a submission does not meet the definition of a buildup and is denied, the patient cannot be billed.
Denials for buildups can be a source of frustration; it is important to be aware of the criteria before submitting a claim. If you do get a denial and wish to appeal the decision, be sure to provide additional detail in the form of radiographs, photos and/or a narrative.
Michael D. Weitzner, DMD, MS
Dental Director, Delta Dental of Virginia
