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#1 Posted : Tuesday, July 7, 2020 1:15:48 PM(UTC)

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Hi! I have a child (13 years old) that was seen for a pontic (ADA code D6245) and a retainer (ADA code D6548). I submitted the claim to dental and claim was denied, they do not cover congenitally missing teeth. I found the code K00.0 for the reason, but don't know what the code would be for the pontic and retainer. Thank you for your help!!!

#2 Posted : Tuesday, July 7, 2020 4:47:36 PM(UTC)

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Hi Guest!

D6245 - pontic - porcelain/ceramic
D6548 - Retainer - porcelain/ceramic for resin bonded fixed prosthesi

There are not a direct crosscodes we are aware of for these services, so you can either use the "D" code on the pre-authorization request/medical claim (many insurers these days will process "D" codes when they are medically necessary services), or you can use the CPT code below and include a narrative report describing the service:
41899 - Unlisted procedure, dentoalveolar structures

Hope this helps!
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