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For buildups (D2950), the American Dental Association’s Current Dental Terminology (CDT) nomenclature states: “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.”
This definition underscores that the procedure is not intended for filler purposes, but rather for restoring substantial coronal structure to support a crown.
Delta Dental’s clinical criteria
Delta Dental aligns with the ADA’s definition and further clarifies that a buildup is generally indicated when the following criteria are met:
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Structural Loss: 50% or more of tooth structure is carious or fractured and/or evidence of cuspal fracture.
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Subgingival Preparation: The preparation is at or below the gingival crest.
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Lack of Opposing Wall Continuity: Less than 3 millimeters of sound dentin remains vertically above the preparation line in opposing walls where the crown's margin will be located.
What does not qualify as a buildup
Procedures that only involve:
- Filling undercuts, box forms, or irregularities
- Occlusal or lingual restorations to fill endodontic access preps
If the procedure does not meet the criteria, insurance will deny the claim and the patient cannot be billed for the service.
Tips to avoid denials
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Document thoroughly: Include radiographs, intraoral photos and a detailed narrative.
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Verify criteria: Ensure that the clinical indicators are met before submitting.
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Appeal effectively: If denied, submit additional documentation to support the necessity of the buildup.
Understanding the CDT definition and Delta Dental’s criteria for D2950 can help reduce denials and ensure proper reimbursement. When in doubt, document clearly and comprehensively.
Michael D. Weitzner, DMD, MS
Dental Director
Delta Dental of Virginia
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