What Is Dental Code D6245 for a Pontic Restoration?
Decode dental code D6245 for pontic restorations. Gain clarity on this specific treatment and its insurance considerations for effective care.
Dental codes serve as a standardized language, facilitating clear communication among dental professionals, patients, and insurance providers. Current Dental Terminology (CDT) codes are maintained and updated annually by the American Dental Association (ADA). They ensure uniformity and consistency in documenting dental treatments, essential for accurate billing and efficient processing of dental claims. These codes help define procedures, enabling proper record-keeping and supporting dental practice operations.
Decoding Dental Code D6245
Dental code D6245 specifically identifies a “pontic – porcelain fused to high noble metal” procedure. The initial “D” signifies it is a dental procedure code, part of the broader system used to categorize all dental services. The numbers “6245” pinpoint the prosthetic component and its material composition.
A pontic refers to a false tooth that is part of a dental bridge, designed to replace a missing tooth. The material “porcelain fused to high noble metal” indicates the specific construction of this artificial tooth. A substructure made of high noble metal is covered with layers of porcelain.
High noble metal is a dental alloy with a high content of noble metals, typically at least 60% by weight, with at least 40% gold. Common noble metals include gold, platinum, and palladium, chosen for their durability, biocompatibility, and resistance to corrosion. The porcelain layer is bonded to this metal framework, providing a natural tooth-like appearance and ensuring the pontic blends aesthetically with existing teeth.
The Role of a Pontic in Dental Restorations
A dental bridge is a fixed prosthetic device that replaces one or more missing teeth by spanning the gap. This restoration consists of one or more pontics (artificial teeth), anchored by dental crowns on natural teeth or implants adjacent to the gap. These anchoring crowns are referred to as abutments.
The pontic’s primary function is to fill the space left by a missing tooth, restoring aesthetic appearance and the functional ability of the patient’s bite. By replacing the missing tooth, a pontic helps maintain the alignment of surrounding teeth, preventing them from shifting into the empty space. This stability is important for preserving proper chewing function and overall oral health.
The pontic receives support from the adjacent abutment teeth or implants, forming a continuous unit that acts as a single, strong restoration. This integrated structure allows for the distribution of chewing forces across the bridge, preventing excessive strain on any single tooth. The selection of a D6245 pontic, with its specific material, is based on factors such as strength requirements, aesthetic considerations, and compatibility with the patient’s oral environment.
Understanding Insurance Coverage for D6245
Insurance coverage for dental procedures like D6245, which involves a pontic as part of a dental bridge, varies among different dental insurance plans. Most plans classify bridges as major restorative procedures, meaning they have different coverage percentages compared to preventive or basic services. Patients are responsible for a larger portion of the cost for major procedures.
Common financial elements of dental insurance plans for D6245 include deductibles, the amount the patient must pay out-of-pocket before the insurance company begins to cover costs. Co-insurance percentages dictate the portion of the covered service cost the patient is responsible for after meeting the deductible, often ranging from 20% to 50% for major services. Most plans also have an annual maximum, the total amount the insurance company will pay for covered dental services within a benefit year.
Patients should review their Explanation of Benefits (EOB) statements to understand how their plan processed a claim for D6245, detailing what was covered and what remains the patient’s responsibility. It is advisable to request a pre-authorization from the dental provider for procedures involving this code. Pre-authorization provides an estimate of what the insurance plan will cover before treatment begins, helping patients anticipate their out-of-pocket expenses. Some plans may have waiting periods for major restorative work, meaning a certain amount of time must pass after enrollment before coverage for such procedures becomes active.