Most common D5245 code reviews : Typical crown benefits for the replacement of an existing crown range from five to seven years before a replacement crown payment will be permitted, Posterior-anterior or lateral skull and facial bone survey radiographic image or Resin-based composite - four or more surfaces or involving the incisal angle (anterior).
Prophylaxis-adult. For payment purposes, the distinction between the adult and child dentition is determined by contract. Any fee in excess is Disallowed and not chargeable to the Patient. In the absence of group contract language regarding age, a person age fourteen (14) and older is considered an adult for benefit determination purposes of a prophylaxis-adult.
Procedure in D5245 which the nearly exposed pulp is covered with a protective dressing to protect the pulp from dditional injury and to promote healing and repair via formation of secondary dentin This code is not to be used for bases and iners when all caries has been removed.
A patient presents with a carious pulp exposure of tooth T There is no succedaneous tooth #29 present on a radiograph The roots of this tooth are of adequate length to allow normal function Endodontic treatment is requested on tooth T in order to maintain this tooth in the arch and facilitate the placement of a functional, final restoration. Root canal treatment is performed on the tooth, and the canals are filled with gutta-percha. A temporary restoration is placed, and the patient is referred back to the referring dentist for a final restoration.
Prefabricated post and core in addition to crown is payable only on a completed endodontically treated tooth. If sufficient tooth structure remains, the fee for the post and core is Disallowed. **A prefabricated post and core for an anterior tooth is Benefited only when there is insufficient tooth structure to support an indirectly fabricated restoration. If sufficient tooth structure remains, the fee for the post and core is Disallowed.
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