When is D2982 used?
The D2982 dental code applies to onlay repairs when the restoration itself fails, rather than problems with decay or tooth structure damage. This code covers situations where existing onlays—composite or metal—develop issues like chipping, edge deterioration, or material loss that require repair instead of complete replacement. Using D2982 correctly helps dental practices receive proper payment for repair procedures while providing patients with conservative treatment options.
D2982 Charting and Clinical Use
Proper record-keeping is essential for D2982 billing. Clinical records must clearly detail the onlay's condition, describe how the restoration material failed (such as edge breakdown, chips, or material loss), and outline the repair work completed. Photos and X-rays help support the treatment decision. Typical situations include:
A patient has a chipped composite onlay while the tooth underneath remains healthy.
Edge deterioration appears around a metal onlay, requiring composite repair material.
Part of the onlay breaks away, but the remaining portion works well and stays secure.
Documentation should always distinguish between restoration problems (correct for D2982) and issues from decay or broken teeth (which need different codes, such as D2980 for crown repairs).
Billing and Insurance Considerations
These strategies improve D2982 claim approval rates:
Pre-approval requests: Submit treatment authorization with supporting records, including notes and photos when available.
Clear descriptions: Write brief explanations on claim forms describing the repair need and confirming the problem involved only the restoration material.
Include evidence: Add photos, X-rays, and other relevant materials showing the onlay condition before and after treatment.
Check responses: Review insurance responses carefully for denials or information requests, and prepare appeals with additional records when necessary.
Confirm benefits: Many dental plans don't cover onlay repairs. Always check coverage during benefit verification and discuss possible patient costs upfront.
How dental practices use D2982
A patient comes in for a regular checkup, and the dentist finds that a ceramic onlay on tooth #14 has a small chip along the edge, though the tooth remains healthy and the onlay stays secure. The dentist smooths the area and fixes the chip using composite material. The treatment notes record where the chip occurred, how large it was, confirm no decay or tooth damage exists, and list repair materials used. The insurance claim uses D2982, includes before-and-after pictures, and explains, "Ceramic onlay repair on #14 for edge chipping of restoration material; no new decay or damage found." This complete documentation approach improves approval chances and ensures correct payment.
Common Questions
Is it possible to bill D2982 alongside other restorative procedures in the same appointment?
Typically, D2982 cannot be billed with other restorative codes for the same tooth during a single visit, since this code specifically covers onlay repair only. When additional restorative procedures are needed on the same tooth, such as placing a new onlay or different restoration, the appropriate separate CDT code must be used instead. It's essential to review the patient's insurance policy for any bundling restrictions or exclusion rules.
What are the typical frequency limits for D2982 billing on the same tooth under dental insurance coverage?
Dental insurance plans commonly impose frequency restrictions on repair codes such as D2982. Usually, repair procedures are covered once every several years per individual tooth, though specific limitations vary between insurance providers. Confirming the patient's particular policy details is crucial to determine whether previous repairs or replacements might impact coverage eligibility for subsequent D2982 claims.
What supporting materials should be provided when appealing a rejected D2982 claim?
For D2982 claim appeals, submit thorough clinical documentation describing the onlay failure and repair process, along with before-and-after photographs, relevant radiographic images, and a detailed narrative justifying why repair was medically necessary over replacement. Directly respond to the denial reason listed in the Explanation of Benefits and include any supplementary evidence that demonstrates the treatment's medical necessity.