Based on a predetermination with Delta Dental, they have informed me that billing D2954 in addition to D2740 for 2 teeth, each with over 7-year-old root canal treatment and crowns, and evident recurrent caries on radiographs, is not permitted. I find it perplexing that they not only refuse coverage but also prohibit billing the patient, especially considering Delta’s already low fees.

The rationale provided was the insufficient demonstration of missing tooth structure. The representative mentioned that D2954 would be considered part of the crown procedure and, if inadequate missing tooth structure is shown, it would be deemed a non-billable procedure. While I plan to bill for D0350 intraoral photos, I am hesitant to bear the costs associated with D2950 or D2954.

I have submitted the following items for review:

  1. Chart notes in SOAP note format
  2. Recently taken FMX
  3. Full perio charting
  4. Narratives detailing the procedure history for D2740, noting the absence of posts in the current crowns.

Has anyone encountered a similar situation or have any insights to share?

admin Changed status to publish December 15, 2023