Policy No: 12
Originally Created: 03/01/1997
Last Reviewed: 01/01/2019
Last Revised: 01/01/2018
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 these codes. If pins are used, they should be reported separately (see D2951).
|Resin based composite||D2330||one surface,anterior|
|Resin based composite||D2331||two surfaces, anterior|
|Resin based composite||D2332||three surfaces, anterior|
|Resin based composite||D2335||four or more surfaces or invoving incisional angle (anterior)|
|Resin based composite||D2390||anterior|
|Resin based composite||D2391||one surface, posterior|
|Resin based composite||D2392||two surfaces, posterior|
|Resin based composite||D2393||three surfaces, posterior|
|Resin based composite||D2394||four or more surfaces, posterior|
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.
Process to contract benefits.
CDT - D2000-D2999 - see above
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