Direct Resin Restorations

Policy No: 12
Originally Created: 03/01/1997
Section: Restorative
Last Reviewed: 01/01/2019
Last Revised: 01/01/2018
Approved: 01/01/2018
Effective: 01/01/2018

Description

Preventive resin restoration in a moderate to high caries risk patient – permanent tooth (D1352)

Direct resin restorations (D2330-D2394)

Resin-based composite refers to a broad category of materials including but not limited to composites. May include bonded composite, light-cured composite, etc. Tooth preparation, acid etching, adhesives (including resin bonding agents), liners and bases and curing, are included as part of the restoration. Glass ionomers, when used as restorations, should be reported with the following codes. If pins are used, they should be reported separately (see D2951).

ProcedureCodeDescription
Resin based compositeD2330one surface, anterior
Resin based compositeD2331two surfaces, anterior
Resin based compositeD2332three surfaces, anterior
Resin based compositeD2335four or more surfaces or involving incisional angle (anterior)
Resin based compositeD2390anterior
Resin based compositeD2391one surface, posterior
Resin based compositeD2392two surfaces, posterior
Resin based compositeD2393three surfaces, posterior
Resin based compositeD2394four or more surfaces, posterior


Policy/criteria

Procedures are in accordance with generally accepted standards of dental practice.

Light curing, acid etching, adhesives, liners and bases are included as part of restorations.

Administrative guidelines

Process to contract benefits.

Codes

CDT - D2000-D2999 - see above

Disclaimer

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