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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!!!
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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