When is D2980 used?
The D2980 dental code applies to crown repair procedures when restoration is needed due to material breakdown, excluding cases involving new decay or traumatic injury. This CDT code covers situations where an existing crown—complete or partial coverage—stays structurally sound but shows chipping, cracking, or material loss that allows for repair rather than full replacement. Dental professionals should apply D2980 only when repair is clinically appropriate and the crown's foundation remains stable.
D2980 Charting and Clinical Use
Accurate record-keeping is crucial for proper reimbursement when submitting D2980 claims. Dental offices must maintain comprehensive clinical records detailing the crown's material breakdown, backed by intraoral images and X-rays when applicable. Typical clinical situations include:
Broken porcelain on porcelain-fused-to-metal crowns with undamaged metal framework
Missing composite or ceramic veneer on front teeth crowns
Damaged ceramic on zirconia crowns suitable for chairside repair
Document the crown's initial placement date and identify the materials involved. This data assists insurance companies in evaluating coverage and reduces claim rejections.
Billing and Insurance Considerations
To optimize reimbursement and reduce processing delays, implement these recommended practices for D2980 billing:
Check benefit coverage: Crown repair benefits vary by plan, so verify patient eligibility during benefit verification and document coverage details.
Include supporting materials: Provide clinical documentation, comparison photographs, and X-rays with claims. Clearly explain why repair rather than replacement is clinically justified.
Write clear descriptions: Include brief narratives describing the material breakdown and repair method used.
Handle claim rejections: When claims are denied, examine the explanation of benefits, collect additional evidence, and file detailed appeals explaining the clinical situation.
Understand alternative codes: When crowns require replacement due to decay or structural damage, consider using complete crown replacement codes instead.
How dental practices use D2980
A patient arrives with damaged porcelain on a four-year-old PFM crown affecting tooth #8. The crown's metal base remains undamaged, showing no signs of decay or tooth damage. The dentist restores the porcelain using bonded composite repair material. Documentation includes the original crown date, detailed photographs showing the damage and completed repair, plus narrative notes explaining the material failure repair. The practice submits the claim using D2980 with complete supporting materials and clear explanations, resulting in approved reimbursement.
Common Questions
Can code D2980 be submitted multiple times for the same crown when additional repairs become necessary?
Yes, D2980 may be billed multiple times for the same crown when separate, clinically warranted repairs are required at different intervals. Each repair instance must include proper documentation with clear clinical justification demonstrated through detailed notes and supporting evidence. Be aware that certain insurance policies may impose frequency restrictions, so it's essential to confirm coverage parameters prior to treatment.
Does the reimbursement amount for D2980 vary depending on the crown material type such as porcelain, ceramic, or metal?
Generally, D2980 reimbursement rates remain consistent regardless of crown material since this code applies to repairs of all crown types. Some insurance providers may require additional documentation or maintain specific guidelines for particular materials. It's recommended to provide comprehensive descriptions along with clear photographs showing both the crown material and completed repair work to strengthen claim approval.
What documentation elements should be incorporated in the narrative for D2980 claim submissions?
An effective D2980 narrative should specify the crown type and restorative materials involved, detail the exact nature and location of the crown failure, confirm the absence of underlying caries or traumatic damage, and provide a comprehensive step-by-step account of the repair methodology used. Supporting the claim with before-and-after photographs plus any pertinent radiographic images will significantly enhance documentation quality and improve reimbursement prospects.