This month I discuss how and what to pay attention to when submitting for porcelain/ceramic onlays. Find out how to get it covered by most dental plans.
D2642: Onlay porcelain/ceramic - two surfaces
D2643: Onlay porcelain/ceramic - three surfaces
D2644: Onlay porcelain/ceramic - four surfaces
Purpose: To replace the cusp(s) of a single tooth using a laboratory-processed or CAD/CAM porcelain ceramic “puzzle piece." There are many variables involved when it comes to dental insurance coverage and reimbursement.
- Most insurance plans will pay for an onlay once every 10+ years, due to limitations.
- Submitting a clear written narrative explaining the number of cusps and surfaces replaced and long-term prognosis can help facilitate approval in most cases.
- If replacement, provide previous seat date and reason for replacement (i.e., open margins, distal decay).
- If reporting a buildup or resin composite on the same tooth at the same visit, insurance plan will deny.
- Providing x-rays, narrative, recent periodontal charting and photographs will ensure a smooth claim approval or denial and alleviate the need to submit additional information to the insurance company at a later date.
Kyle L. Summerford is a nationally recognized practice management guru, author, and lecturer. He is founder and president of Summerford Solutions Inc., and cofounder of Elitedentalclaims.com. Kyle also serves as editorial director of Dental Office Manager Digest e-newsletter. He lectures extensively to dentists and their staff on topics such as insurance coding and billing and useful practice management tips. Contact him at [email protected].