Onlay Porcelain/Ceramic Three Surfaces - CDT Code Guide
Overview
CDT Code D2643 refers to the placement of a three-surface onlay made of porcelain or ceramic materials. This restorative procedure is typically used when a tooth has suffered significant damage or decay that cannot be adequately repaired with a simple filling but does not require a full crown. The onlay covers one or more cusps of the tooth, providing strength and protection while maintaining a natural appearance. This procedure is often chosen for its durability and aesthetic appeal, making it a preferred option for restoring posterior teeth that endure significant chewing forces.
When to Use This Code
- When a tooth has extensive decay affecting three surfaces but is not severely compromised.
- For teeth with large, failing fillings where a crown is not yet necessary.
- To restore a fractured tooth with intact root structure.
- In cases where esthetic restoration is preferred for posterior teeth.
- When preserving as much natural tooth structure as possible is a priority.
Documentation Requirements
- Detailed chart notes describing the extent of decay or damage.
- Pre-operative and post-operative radiographs to support the necessity of the onlay.
- Patient consent forms acknowledging understanding of the procedure.
- Clinical photographs may be beneficial for insurance documentation.
- A detailed narrative explaining why a crown was not chosen.
Billing Considerations
When billing for D2643, it's important to verify the patient's insurance coverage for onlays, as some plans may have specific limitations or exclusions. Frequency limitations may apply, so check if the patient has had similar procedures recently. Common modifiers include those for multiple restorations in the same quadrant. Always confirm whether the insurance plan covers porcelain/ceramic materials, as some may only cover metal restorations.
Related CDT Codes
Frequently Asked Questions
An onlay covers one or more cusps of a tooth, preserving more natural tooth structure, while a crown covers the entire tooth.
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