What Are the Codes to Report Supernumerary Teeth?

What Are the Codes to Report Supernumerary Teeth?

Supernumerary teeth refers to a common dental condition wherein extra teeth grow inside the mouth. Also called hyperdontia, these extra teeth can grow anywhere in the curved areas (dental arches) where teeth attach to the jaw line. The prevalence of this dental condition is twice as common in adult males than in adult females. In fact, the majority of cases of supernumerary teeth appear as a single tooth, but sometimes multiple teeth are present, appearing separately or in clusters. The exact factors that cause this dental condition are not fully known. However, researchers say that a combination of several hereditary factors and birth defects can contribute to this condition. Billing and coding for this specific dental condition can be challenging. Reliable dental billing services provided by AAPC-certified coding specialists can help in accurate and timely billing and claims submission.

Symptoms of Supernumerary Teeth

As mentioned above, supernumerary teeth can appear anywhere in the mouth and are mostly found among the permanent teeth. However, they also occur among baby teeth, but tend to be harder to identify, as they often erupt normally, are shaped like other teeth, and are in correct alignment. This dental condition is classified by way of shape and by way of location. The sudden growth of extra teeth directly behind or close to the usual primary or permanent teeth is one of the primary symptoms of this dental disorder. The extra teeth can appear in anyone but are more often associated with people who have Gardner’s syndrome (a rare genetic disorder), Down syndrome, Ehlers-Danlos syndrome, Cleidocranial dysplasia, Fabry disease and those born with a cleft lip and palate.

Generally, the condition isn’t painful. However, in certain cases, it can put extra pressure on the jaw and gum lines, making them swollen and painful. If not treated properly, a variety of dental problems may develop, such as – tooth impaction, crowding, displacement, and misalignment of normal permanent teeth, premature closure of spaces in between the teeth, formation of oral cysts or tumors, eruption of teeth into the nasal cavity and issues with proper chewing. Overcrowding caused by this condition can make permanent teeth look crooked.

Diagnosing and Treating Supernumerary Teeth

Diagnosis of this dental disorder is quite easy if the extra teeth have already grown. However, if they have not grown in fully, diagnosing can be quite difficult. In such cases, imaging tests such as – dental X-rays and CT scans may be performed for a more detailed analysis of the mouth, jaw, and teeth. Certain cases of hyperdontia do not require any specific treatment, while other cases involve removing the extra teeth. For instance, if the extra teeth is affecting a person’s dental hygiene or causing other problems such as – chewing problems, pain or discomfort while brushing /flossing teeth, or delaying the eruption of permanent teeth, it is better to remove them.

Treatment for this dental disorder depends on the type and position of the supernumerary teeth and how it affects the adjacent teeth. If the extra teeth cause only mild discomfort, the dentist may recommend non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) for pain. Other treatment modalities include – removal of the teeth when possible (performed under local or general anesthesia). In certain other cases, supernumerary teeth may need to be cut and then removed in pieces. Endodontic treatment (also known as a root canal) may also be done to treat the tooth pulp as well as surrounding tissues.

ICD-10 Codes for Supernumerary Teeth

The treatment modalities and other screening tests performed by dentists, orthodontists, and other dental specialists must be carefully documented using the correct medical codes. Billing and coding services provided by an established medical billing and coding company can help physicians use the correct codes for their billing purposes. ICD-10 codes for supernumerary teeth include –

  • K00 Disorders of tooth development and eruption
  • K00.0 Anodontia
  • K00.1 Supernumerary teeth
  • K00.2 Abnormalities of size and form of teeth
  • K00.3 Mottled teeth
  • K00.4 Disturbances in tooth formation
  • K00.5 Hereditary disturbances in tooth structure, not elsewhere classified
  • K00.6 Disturbances in tooth eruption
  • K00.7 Teething syndrome
  • K00.8 Other disorders of tooth development
  • K00.9 Disorder of tooth development, unspecified

As mentioned above, most cases of supernumerary teeth do not require any specific treatment. In other cases, patients need to remove some or all of their extra teeth to avoid further problems. It is not necessary to remove natal teeth unless the supernumerary teeth are loose and present a risk for aspiration due to passage into the lung.

Medicaid Coverage for Orthodontics

Medicaid Coverage for Orthodontics

Medicaid programs are predominantly aimed at covering dental services for children and youth under the age of 21. There are certain states that give adult dental benefits. However, there is no health coverage for orthodontic treatments that are rendered for cosmetic reasons. Medicaid provides coverage benefits only for orthodontic procedures that are a medical necessity. Poor oral health is a cause of concern in the United States and it particularly impacts people with low incomes. Taking this into consideration, Medicaid provides dental services such as check-ups, cleanings, fillings, and extractions. For example, Early and Periodic Screening, Diagnostic and Treatment benefit (EPSDT) is Medicaid’s comprehensive child health program.

Medical necessity

Medical necessity is an important factor for a patient to be eligible for Medicaid-reimbursable therapy and treatment services. The definitions of medical necessity in states are based on certain constraints and they vary from state to state. Some states reduce Medicaid costs by having cost restrictions in place. This is done by limiting patients to the least expensive treatments. One of the common restrictions on states’ definitions of medical necessity is prohibitions against experimental treatments. Whereas in some states, the definition of medical necessity is broad. The opinion of orthodontists that are pertinent to the medical condition is taken into consideration.

Applicability of Medicaid coverage in some common dental problems

As mentioned above, the dental problems that are covered under Medicaid programs differ from state to state. Here are two important orthodontic procedures and the applicability of their Medicaid coverage.

Dental Anesthesia procedure:

With reference to ND Medicaid dental manual, the following procedures are reimbursed in North Dakota

  • D9222: Deep sedation/general anesthesia -first 15 minutes
  • D9223: Deep sedation/general anesthesia -each 15-minute increment
  • D9239: Intravenous moderate (conscious) sedation/analgesia-first 15 minutes
  • D9243: Intravenous moderate (conscious) sedation/ analgesia- each 15-minute increment

Dental anesthesia procedures have to be documented accurately in states that provide Medicaid coverage for the same. Dental practices can rely upon dental billing companies for error-free compilation of dental codes that are eligible for reimbursement.

Dental benefits of children and Medicaid coverage programs with reference to Medicaid.gov

  • In most states, the medical bills for dental procedures of children are extensively covered. As per Medicaid.gov, the dental services of all child enrollees of Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit are covered.
  • Oral screening is a part of a physical exam but it doesn’t substitute for a dental examination performed by the dental practice.
  • The dental service for children must minimally include:
    • Relief of pain and infections
    • Restoration of teeth
    • Maintenance of dental health
  • The EPSDT mandates that all services must be provided if they are a medical necessity. Medical necessity is decided by states.
  • If a condition is diagnosed during dental screening, the state is required to provide all the necessary services to treat that condition, regardless of their inclusion in the state’s Medicaid plan.
  • Dental services are not limited to emergency services for children entitled to EPSDT.
  • Dental services have to be provided at intervals that meet reasonable standards of dental practice. In such intervals with regard to medical necessity, the existence of suspected illness or condition has to be determined.

Medicaid coverage for braces for children

Dental braces – Orthodontic codes

  • D8210: Removable appliance therapy
  • D8220: Fixed appliance therapy
  • D8060: Interceptive orthodontic treatment of the transitional dentition
  • D8080- Comprehensive orthodontic treatment of the adolescent dentition

If braces are deemed a medical necessity for the child, they will be covered under Medicaid Program. An orthodontist or dentist confirms if braces are medically necessary for the child. According to mykoolsmiles.com, below given are some of the considerations that are used to determine medical necessity:

  • Cleft palate
  • Structural jaw issues making it difficult to open your mouth
  • Issues with eating or chewing normally
  • Issues with eating or chewing normally
  • Issues with speech impediments from tooth or jaw problems
  • Any extreme underbite, crossbite, or overbite
  • Overjet teeth -When teeth protrude outwardly and sit over the bottom teeth
  • Impacted teeth with an eruption
  • Missing teeth due to hereditary conditions (like hypodontia)

The services provided by dental practices have to be documented correctly to eliminate claim denials. A dental billing company can assist dental practices in assigning appropriate dental codes in accordance with the Medicaid plan of the state concerned.

Dental and Medical Billing Guidelines for Frenectomies

Dental and Medical Billing Guidelines for Frenectomies

Frenectomy procedures are performed primarily on infants, and it involves the removal of one or both frena from the mouth. As per the statistics given by the American Academy of Pediatric Dentistry, the number of frenotomy/frenectomy procedures performed is growing with a 90 percent increase in recent years. As the ADA (American Dental Association) changes the CDT (Current Dental Terminology) codes frequently, dental practices are required to adopt the changes and ensure accuracy in their claims. A dental billing company can help with complete and accurate documentation of dental procedures.

Frenectomy – A Covered Dental Procedure;

Frenectomy is considered medical in nature due to the following two reasons:

  • There is a problem feeding the newborns
  • It is required to correct congenital malformation( Ankyloglossia)

It implies that a frenectomy is medically necessary and is accompanied by the following symptoms, according to provcomm.ibx.com:

  • Difficulty feeding/eating
  • Difficulty chewing ( mastication)
  • Difficulty swallowing
  • Speech impairment or difficulty with articulation

The procedures used to treat the lingual frenum (other than for ankyloglossia), the labial frenum and the buccal frenum are considered dental procedures. Dental practices have to take note of the fact that they are not covered under medical plans and are considered benefit contract exclusions.

CPT Codes for Frenectomy or Frenotomy

  • 41010

In this procedure, the provider makes an incision in the lingual frenum, a membranous ridge under the tongue, to allow greater movement of the tongue in patients with ankyloglossia.

  • 41115

In this procedure, the provider makes an incision at the base of the tongue and excises the frenum.;

  • 40806

The provider incises the labial frenum, the tag of tissue in the center of the upper or the lower lip that attaches the lip to the gums of the patient. The provider does not remove the frenum. The provider commonly performs this procedure to release a tight frenum and its surrounding tissues.

  • 40819

In this procedure, the provider removes the labial or buccal frenum, each of which is a membrane structure in the mouth. Labial refers to the lip and buccal refers to the cheek.

  • 41115

In this procedure, the provider makes an incision at the base of the tongue and excises the frenum.

ICD-10 Codes

  • Q38.1

Ankyloglossia

For feeding difficulties:

  • R63.3 – Feeding difficulties
  • P92.5- Neonatal difficulty in feeding at the breast
  • P92.8- Other feeding problems of newborn
  • P92.9- Feeding problem of newborn, unspecified

For childhood articulation problems:

  • F80.0- Phonological disorder
  • F80.89-Other developmental disorders of speech and language
  • F80.9- Developmental disorder of speech and language, unspecified

CDT Codes

The below-mentioned codes are newly added CDT codes and are effective from 01/01/2021.

  • D7961- Buccal / labial frenectomy (frenulectomy)
  • D7962- Lingual frenectomy ( frenulectomy)

Guidelines to Follow While Claiming Dental Insurance

  • To facilitate coverage and payment, submitting the claim with x-rays alone is insufficient.
  • The above-mentioned codes are applicable only if the procedure involves removing a patient’s frenum.
  • Carefully consider the patient’s plan limitations and exclusions.
  • The claims of this procedure are limited to once per lifetime, per tooth.
  • If connective tissue graft or pedicle graft is reported on the same visit as the frenectomy, the frenectomy is considered inclusive with no additional payments.
  • According to dentistryiq.com, a narrative should also be included which indicates the following:
    • Amount of gingival recession in millimetres
    • The severity of gingival inflammation
    • The level of sensitivity
    • Bleeding on probing
  • The claim form should be accompanied by pre-op and post-op x-rays in addition to periodontal charting.

General Guidelines for Medical Billing for Dental Surgery

According to dentalproductsreport.com, to successfully place dental claims, the following has to be accurately documented:

  • The primary presenting situation
  • Any secondary, supporting diagnosis
  • The diagnosis code for the treatment
  • Surgical pre-authorization
  • Medical necessity, in the form of a letter of medical necessity
  • Support from the patient’s primary care physician, in the form of a supporting letter of medical necessity
  • The procedures performed at each surgery location

This is vital information that is required by the medical insurance company to get a comprehensive understanding of the care provided.

  • Prior-authorization

Frenectomy procedures require a pre-authorization. The insurer has to be contacted via phone to explain the procedure and the date. Reimbursement claims will be rejected if pre-authorization is not obtained.

  • Verification of insurance

Dental eligibility verification is essential to gather information about the coverage for this surgery. The following information must be collected from the patients first:

  • Name of the primary insured
  • Social security number of the primary insured
  • Insurance carrier
  • ID number
  • Group number
  • Contact details of the insurance company like phone number, web address and residential address for submitting claims.
  • Proving medical necessity

A frenectomy is performed as a medically necessary procedure. Accurate medical coding is vital. Coding should inform the payer that the procedure was performed and the reason that the patient’s concern was medical rather than just a dental problem

  • Accurate coding

Appropriate ICD-10 codes and CPT codes have to be incorporated in the Letter of Medical Necessity. According to Dental Practice Management, dental practices have to limit themselves to entering only four diagnostic codes in the Letter of Medical Necessity. The most important procedure should be listed first, followed by the procedures of a lesser importance.

  • Documenting and submitting the claims

After the dental surgery, the next important step is filling in the claims submission form correctly. A thorough look over the forms is necessary to identify typos or missed information. The claim must be submitted to the insurer with appropriate documentation. Lab or diagnostic imaging studies are also to be submitted along with the claims as supporting documents.

Compared to billing for other medical specialities, dental billing is complex. An experienced dental billing company can help dental practices to improve dental billing collections and ROI, particularly for services like frenectomies where prior authorization is required.

Dental Billing Codes for Surgical Periodontic Procedures

Dental Billing Codes for Surgical Periodontic Procedures

Periodontal diseases need to be treated on time to prevent any infection. If non-surgical treatment options fail, dentists may recommend surgical periodontic procedures to prevent future gum damage, remove bacteria from beneath the gums, and reshape the bones that support the teeth. Periodontal surgery comprises several procedures such as gingival flap surgery, mucogingival surgery, and osseous surgery. Dental practices can report such procedures on insurance claims using specific CDT and ICD-10 codes. Consider partnering with a professional dental billing company that can provide support in submitting clean dental claims.

CDT Codes for Surgical Periodontic Procedures

Gingivectomy

Gingivectomy refers to the surgical removal of gingival or gum tissue. The procedure is mainly done to treat gingivitis and for cosmetic purposes. The surgery involves removing a portion of the gums around a tooth or teeth, which can lengthen the height or width of a tooth or a section of teeth. 

  • D4210 Gingivectomy or gingivoplasty – four or more contiguous teeth or tooth bounded spaces per quadrant
  • D4211 Gingivectomy or gingivoplasty –one to three contiguous teeth or tooth bounded spaces per quadrant
  • D4212 Gingivectomy or Gingivoplasty to allow access to restorative procedure, per tooth
  • D4240 gingival flap procedure, including root planing – four or more contiguous teeth or tooth bounded spaces per quadrant
  • D4241 gingival flap procedure, including root planing – one to three contiguous teeth or tooth bounded spaces per quadrant
  • D4346 scaling in presence of generalized moderate or severe gingival inflammation- full mouth, after oral evaluation
  • D4921 gingival irrigation- per quadrant
  • D7971 excision of per coronal gingival

Dental Crown Lengthening 

For better oral hygiene and comfort, dental crowns need to be properly fixed. A dental crown lengthening procedure helps correct excess gum tissue covering the teeth. The procedure is performed by recontouring gum tissue or bone, which exposes more of a tooth’s surface for a crown.

  • D4249 Clinical crown lengthening – hard tissue 

Osseous Surgery 

This surgery is performed to manage the destruction caused by periodontal gum disease. Subtypes of osseous surgery include the bone reshaping or resectioning procedures and bone stimulative procedures. While osteotomy can reshape bones, osteotomy can correct bone defects and create normal bone contours. 

  • D4260 Osseous surgery (including flap entry and closure) – four or more contiguous teeth or tooth bounded spaces per quadrant 
  • D4261 Osseous surgery (including flap entry and closure) – one to three contiguous teeth or tooth bounded spaces per quadrant 

Mesial/Distal Wedge

This surgical procedure is done following the extraction of a wisdom tooth.  It helps to remove the additional tissue that is covering a portion of the back teeth in the gap left by the wisdom tooth. This surgery involves numbing the area using local anaesthesia and removing a small wedge of tissue and suturing the surgical wounds with stitches.

  • D4274 Mesial/distal wedge procedure, a single tooth (when not performed in conjunction with surgical procedures in the same anatomical area) 
  • D4999 Unspecified periodontal procedure, by a report

Anatomical Crown exposure

Anatomical crown exposure is recommended for uneven gum lines and for teeth appearing too short. Here, the excess gum and tissue are removed and the gum line is then sculpted to create a correct proportion between gum tissue and tooth surface.

  • D4230 Anatomical Crown Exposure four or more contiguous teeth
  • D4231 Anatomical Crown Exposure one to three contiguous teeth
  • D4268 Surgical Revision Procedure per tooth

Regeneration

During the regeneration periodontal surgical procedure, the periodontist folds back the gum tissue to eliminate bacteria. It helps in completely restoring the lost tissues.  Even after the procedure, there are chances for epithelial, gingival connective tissue or bone to grow along the root surface.

  • D4265 Biologic materials to aid in soft and osseous tissue regeneration

Soft Tissue Grafting

A gum graft is recommended to protect the teeth from the damaging effects of gum recession or to improve the appearance of the smile. Three different types of gum tissue grafts are connective-tissue grafts, free gingival grafts, and Pedicle grafts.

  • D4270 Pedicle soft tissue graft procedure

Related ICD-10 codes

  • C03 Malignant neoplasm of gum
  • C03.0 Malignant neoplasm of upper gum
  • C03.1 Malignant neoplasm of lower gum
  • C03.9 Malignant neoplasm of gum, unspecified
  • D00.00 Carcinoma in situ of the oral cavity, unspecified site
  • D10.39 Benign neoplasm of other parts of the mouth
  • K05 Gingivitis and periodontal diseases
  • K05.0 Acute gingivitis
  • K05.1 Chronic gingivitis
  • K05.2 Aggressive periodontitis
  • K05.3 Chronic periodontitis
  • K05.4 Periodontosis
  • K05.5 Other periodontal diseases
  • K05.6 Periodontal disease, unspecified
  • K06 Other disorders of gingiva and edentulous alveolar ridge
  • K06.0 Gingival recession
  • K06.1 Gingival enlargement
  • K06.2 Gingival and edentulous alveolar ridge lesions associated with trauma
  • K06.3 Horizontal alveolar bone loss
  • K06.8 Other specified disorders of gingiva and edentulous alveolar ridge
  • K06.9 Disorder of gingiva and edentulous alveolar ridge, unspecified

Choosing the right dental or diagnosis codes for these periodontal surgeries require good knowledge of the changing coding and billing standards. Professional dental billing companies can take care of the time-consuming dental insurance eligibility verification tasks, and thus ensure the smooth flow of revenue for the services provided.

Also Read:
What are the Dental Codes for Gingivectomy?
Documenting and Coding Periodontitis – Know the ICD-10 Codes
Bundling And Down coding Issues in Dental Billing and How to Address Them
ICD-10 and CDT Dental Codes and Their Eligibility Verification
What You Need to Know about Dental Medicaid Coverage According to the State You Live In

What You Need to Know about Dental Medicaid Coverage According to the State You Live In

Medicaid — the taxpayer-subsidized public health program aimed at helping low-income individuals afford health care — provides dental benefits for eligible adults. Dental services are also a required service for most Medicaid-eligible individuals under the age of 21, as a required component of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. Dental billing companies stay abreast of all aspects of insurance and billing, including Medicaid, Medicare, and commercial insurance, and help dentists to provide the best care to patients while maximizing their dental insurance benefits.

Dental insurance is expensive, more so for people looking for comprehensive coverage. Dental insurance plans generally classify dental services into three groups:

Group 1: Preventative and diagnostic care, such as x-rays and cleanings

Group 2: Basic restorative care, including fillings and root canals

Group 3: Major restorative care, including dentures, bridges, and crowns

Whether Medicaid beneficiaries will be covered for these services depends on the state you live in.

Medicaid Coverage for Dental Care by State

Medicaid provides access to oral health care for low-income adults who are eligible for Supplemental Security Income (SSI) benefits, and other individuals in need, including children, disabled and elderly people. However, dental Medicaid financial eligibility requirements for adults differ among states.  Based on the state they live in, patients need to meet different qualifications and requirements for dental care to be covered by Medicaid.

Both dentists and patients need to be aware of the requirements applicable to their designated state. However, as a Dentistry Today article points out, there is a general lack of awareness among those on Medicaid about their dental benefits. According to the ADA Health Policy Institute (HPI), up to 31.3% of people enrolled in Medicaid were not certain about their dental benefits, while 37.7% of those had a misconception of their benefits in their designated state.  So, let’s dive into the topic.

Here are the key points about dental benefits for individuals on Medicaid:

  • Medicaid state-wise dental coverage is categorized as:
  • Extensive
  • Limited
  • Emergency and Medically Necessary
  • No coverage

The following table shows the state’s coverage of dental benefits for adults in Medicaid:

Extensive coverage Arizona, Alaska, California, Colorado, Connecticut, Idaho, Illinois, Iowa, Massachusetts, Montana, NJ, New Mexico, NY, N Carolina, North Dakota, Ohio, Oregon, Rhode Island, Wisconsin, and Washington
Limited coverage

 

Arkansas, Indiana, Kansas, Kentucky, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Pennsylvania, South Carolina, South Dakota, Vermont, Wyoming
Emergency dental services and medically necessary coverage Alaska, Arizona, Florida, Georgia, Hawaii, Maine, Montana, Nevada, New Hampshire, Oklahoma, Texas, Utah, Virginia, and West Virginia
No coverage Alabama, Delaware, Maryland and Tennessee
    • Now let’s look at what coverage under each of these 4 categories means:

Extensive coverage: Washington is one of the states where Medicaid coverage is extensive. Here, Medicaid covered dental services for adults (21 years and older) include:

  • Routine exams
  • Cleaning
  • X-rays
  • Fillings
  • Fluoride application
  • Extractions (pulling teeth)
  • Nitrous Oxide
  • Other limited dental services, include:
  • Periodontal (gum disease)
  • Root canal (front teeth only)
  • Dentures/Partials
  • Oral Surgery

Dental services that Medicaid Washington does not cover for adults include Bridges, Crowns, Implants and Orthodontics.

Some Medicaid covered dental services for eligible children, age 20 and younger, in Washington include:

    • Routine exams
    • Cleaning
    • X-rays
    • Sealants
    • Fillings
    • Crowns
    • Fluoride application
    • Extractions (pulling teeth)
    • Orthodontic services for children with a cleft palate or other serious dental problems (medically necessary services covered with prior authorization).

Limited coverage: Wyoming is one of the states with limited Medicaid coverage. Limited preventive and emergency services are available for Medicaid beneficiaries in this state, but no restorative services.

Children ages 0-20

  • 2 Preventive visits/year (cleanings,
  • exams, x-rays, fluoride)
  • Restorative- fillings, crowns
  • Periodontics- gum treatment
  • Endodontics- root canal therapy
  • Orthodontics- braces
  • Tooth replacement- bridges,
  • implants, dentures, partials
  • Oral Surgery- extractions, jaw surgery,
  • TMJ treatment

Medicaid eligible clients under age 19 may receive treatment for severe malocclusion. Medicaid only reimburses codes D8000-D8999 to enrolled providers who have obtained a Prior Authorization (PA) for treatment in the Wyoming Severe Malocclusion (SM) Program prior to treatment.

Adults ages 21 & older

    • 2 Preventive visits/year (basic cleanings,
    • exams, x-rays)
    • 2 Emergency visits/year
    • Extractions
    • Repair or reline of existing dentures or
    • partial dentures

Emergency dental services and medically necessary coverage: In Florida, Medicaid emergency-based dental services include:

  • Dental Exams (limited)
  • Dental X-rays (limited)
  • Dentures
  • Extractions (removal of teeth)
  • Sedation (dental services while asleep or partly asleep)
  • Problem focused
  • Pain management
  • Some Services may require PA.
  • Extra goods or services the dental plans provide to adult and pregnant adult recipients include:
  • Additional dental exams
  • Dental screenings
  • Additional dental X-rays
  • Teeth Cleanings (basic and deep)
  • Fluoride Sealants
  • Oral Health Instructions
  • Fillings (silver and white)
  • Additional extractions
  • Dental consultations
  • Dental office diabetic testing

Persons with disabilities are covered for a visit to the dental office to get comfortable with the office and the dentist before their dental work.

No coverage: In Alabama, Delaware, Maryland and Tennessee, Medicaid does not cover any type of dental care for adults.

Oral health is crucial for overall health, well-being and quality of life. However, many low-income families do not get the dental care they need. According to the American Dental Association and Centers for Medicare and Medicaid (CMS), the main reason for this is the lack of knowledge among Medicaid beneficiaries about the benefits of being on Medicaid as well as due to the low proportion of dentists who are willing to accept Medicaid dental plans.

The federal government is taking steps to address this challenge by educating people about Medicaid’s dental benefits specific to each state. As the Dentistry Today article notes, though Medicare payment is less than commercial insurance, dentists should realize that accepting more Medicaid patients will increase the practice’s overall revenue. By partnering with a reliable dental billing company, dentists can maximize reimbursement and also get assistance to understand Medicaid coverage in their designated state. Experienced companies provide comprehensive support for dental billing and coding as well as insurance authorization and verification services.

CDT Codes to Report Dental Implant Services

CDT Codes to Report Dental Implant Services

It is necessary to document each component of dental implant services to ensure the highest possible reimbursement. In addition, accurate documentation is also vital from the point of view of ongoing patient care. Implant procedures that meet the threshold of medical necessity are eligible for medical billing. A reputable dental billing company can appropriately code CDT codes during claims submission, based on the insurance availed. 

CDT Codes That Represent Dental Implant Services

  • D6190 

Radiographic/surgical implant index, by the report

  • D6191

Semi-precision abutment –placement

  • D6192

Semi-precision attachment-placement

Surgical Implant Procedure Codes

  • D6010 

Surgical placement of implant body: endosteal implant

  • D6011

Second stage implant surgery

  • D6012

Surgical placement of interim implant body for transitional prosthesis: endosteal implant

  • D6013

Surgical placement of mini implant

  • D6040

Surgical placement: eposteal implant

  • D6050

Surgical placement: transosteal implant

  • D6100

Implant removal, by report

  • D6101

Debridement of a peri-implant defect or defects surrounding a single implant, and surface cleaning of the exposed implant surfaces, including flap entry and closure 

  • D6102

Debridement of the osseous contouring of a peri-implant defect or defects surrounding a single implant and includes surface cleaning of the exposed implant surfaces including flap entry and closure

  • D6103

Bone graft for repair of peri-implant defect does not include flap entry and closure

  • D6104

Bone graft at the time of implant placement 

Implant Supported Prosthetics

  • D6055

Connecting bar-implant supported or abutment supported 

  • D6056

Prefabricated abutment-includes modification and placement 

  • D6057

Custom fabricated abutment-includes placement

  • D6051

Interim abutment

  • D6052

Semi- precision attachment abutment

Implant/ Abutment Supported Removable Dentures

  • D6110

Implant/ abutment supported removable denture for edentulous arch-maxillary

  • D6111

Implant/ abutment supported removable denture for edentulous arch-mandibular

Implant/Abutment Supported Fixed Dentures (Hybrid Prosthesis)

  • D6112

Implant/abutment supported removable denture for partially edentulous arch-maxillary

  • D6113

Implant/abutment supported removable denture for partially edentulous arch-mandibular

  • D6114

Implant /abutment supported fixed denture for edentulous arch-maxillary

  • D6115

Implant/abutment supported fixed denture for edentulous arch-mandibular 

  • D6116

Implant / abutment supported fixed denture for partially edentulous arch-maxillary 

  • D6117

Implant/abutment supported fixed denture for partially edentulous arch-mandibular 

  • D6118

Implant/abutment supported interim fixed denture for edentulous arch-mandibular 

  • D6119

Implant/abutment supported interim fixed denture for edentulous arch-maxillary 

Single Crowns, Abutment Supported 

  • D6058

Abutment supported porcelain/ceramic crown 

  • D6059

Abutment supported porcelain fused to metal crown (high noble metal)

  • D6060

Abutment supported porcelain fused to metal crown (predominantly base metal)

  • D6061

Abutment supported porcelain fused to metal crown (noble metal)

  • D6097

Abutment supported crown-porcelain fused to titanium or titanium alloys

  • D6062

Abutment supported cast metal crown (high noble metal)

  • D6063

Abutment supported cast metal crown (predominantly base metal)

  • D6064

Abutment supported cast metal crown (noble metal)

  • D6094

Abutment supported crown titanium and titanium alloys

Single Crowns, Implant Supported 

  • D6065

Implant supported porcelain/ceramic crown

  • D6066

Implant supported crown-porcelain fused to high noble alloys

  • D6082

Implant supported crown-porcelain fused to predominantly base alloys 

  • D6083

Implant supported crown-porcelain fused to noble alloys

  • D6084

Implant supported crown-porcelain fused to titanium or titanium alloys

  • D6067

Implant supported crown-high noble alloys

  • D6086

Implant supported crown-predominantly base alloys

  • D6087

Implant supported crown-noble alloys

  • D6088

Implant supported crown-titanium and titanium alloys

Fixed Partial Denture (FPD) Retainer, Abutment Supported

  • D6068

Abutment supported retainer for porcelain / ceramic FPD

  • D6069

Abutment supported retainer for porcelain fused to metal FPD (high noble metal)

  • D6070

Abutment supported retainer for porcelain fused to metal FPD (predominantly base metal)

  • D6071

Abutment supported retainer for porcelain fused to metal FPD (noble metal)

  • D6195

Abutment supported retainer-porcelain fused to titanium and titanium alloys 

  • D6072

Abutment supported retainer for cast metal FPD (high noble metal)

  • D6073

Abutment supported retainer for cast metal FPD (predominantly base metal)

  • D6074

Abutment supported retainer for cast metal FPD (noble metal)

  • D6194

Abutment supported retainer crown for FPD-titanium and titanium alloys

Fixed Partial Denture (FPD) Retainer, Implant Supported 

  • D6075

Implant supported retainer for ceramic FPD 

  • D6076

Implant supported retainer for FPD-porcelain fused to high noble alloys

  • D6098

Implant supported retainer-porcelain fused to predominantly base alloys

  • D6099

Implant supported retainer for FPD-porcelain fused to noble alloys 

  • D6120

Implant supported retainer-porcelain fused to titanium and titanium alloys

  • D6077

Implant supported retainer for metal FPD-high noble alloys

  • D6121

Implant supported retainer for metal FPD-predominantly base alloys 

  • D6122

Implant supported retainer for metal FPD-noble alloys

  • D6123

Implant supported retainer for metal FPD-titanium and titanium alloys 

Other Implant Services

  • D6080

Implant maintenance procedures when prostheses are removed and reinserted, including cleansing of prostheses and abutments 

  • D6081

Scaling and debridement in the presence of inflammation or mucositis of a single implant, including cleaning of the implant services, without flap entry and closure 

  • D6085

Provisional implant crown

  • D6090

Repair implant supported prosthesis, by report 

  • D6091

Replacement of semi-precision or precision attachment (male of female component) or implant /abutment supported prosthesis, per attachment 

  • D6092

Re-cement or re-bond implant/abutment supported crown

  • D6093

Re-cement or re-bond implant/abutment supported fixed partial denture

  • D6095

Repair implant abutment, by report

  • D6096

Remove broken implant retaining screw

  • D6199

Unspecified implant procedure, by report

Dental practices must keep up to date with the CDT codes and their changes in order to file the claims correctly. To maintain consistent revenue flow, save time, and deliver excellent patient care, dentists and dental practices should consider utilizing outsourced dental billing services