When is D6212 used?
D6212 is a CDT (Current Dental Terminology) code that applies to pontics constructed from titanium and titanium alloys. A pontic serves as the replacement tooth in a fixed partial denture (bridge) that fills the space of a missing natural tooth. This code is appropriate when titanium is selected as the restorative material, valued for its exceptional strength, longevity, and biocompatible properties. D6212 should be applied in clinical situations requiring a titanium pontic, particularly for patients with sensitivities to other metals or when enhanced durability is essential for the prosthetic restoration.
D6212 Charting and Clinical Use
Proper documentation plays a crucial role in successful claim processing and regulatory compliance. When filing a claim using D6212, the patient record must clearly document:
The specific edentulous area (location of missing tooth) receiving restoration
Clinical justification for selecting a titanium pontic (such as metal sensitivities, requirement for increased durability)
Pre-treatment and post-treatment radiographic images or clinical photographs
Comprehensive notes regarding prosthetic design and material choice
Typical clinical applications include comprehensive implant-supported bridge restorations, cases requiring biocompatible materials, or situations demanding high-strength prosthetics due to significant occlusal stresses.
Billing and Insurance Considerations
To optimize claim approval and reduce rejection rates when submitting D6212, implement these recommended practices:
Confirm benefits: Validate with the insurance carrier that the patient's policy includes coverage for titanium pontics. Coverage varies among plans, and some may require prior authorization.
Provide comprehensive documentation: Include detailed clinical records, radiographic evidence, and written explanation justifying the need for titanium material. Include manufacturer specifications when requested by insurers.
Apply appropriate CDT codes: Ensure D6212 is not mistaken for alternative pontic codes like D6205 (all-ceramic pontic) or D6210 (cast high noble metal pontic). Choose the code that accurately reflects the material utilized.
Address claim rejections: When claims are denied, examine the Explanation of Benefits (EOB) to understand the denial reason and prepare a comprehensive appeal with additional supporting evidence as required.
How dental practices use D6212
A patient presents with a missing mandibular first molar and documented sensitivity to nickel-containing alloys. Following consultation about restoration alternatives, the dentist and patient select a fixed bridge featuring a titanium pontic to ensure biocompatibility. The treatment approach is thoroughly documented, initial radiographs are captured, and a detailed explanation is prepared justifying the material selection. The insurance claim is filed using D6212, accompanied by all relevant supporting materials. When the insurance company requests additional information, the practice promptly provides manufacturer documentation and supplementary clinical details. The claim receives approval, and payment is processed without additional complications.
This practical example demonstrates the significance of complete documentation, proactive insurer communication, and proper understanding of CDT code application for effective practice revenue management.
Common Questions
Is D6212 restricted to posterior teeth only, or can it be applied to anterior teeth as well?
D6212 is applicable to both anterior and posterior tooth locations, provided the pontic is constructed from titanium material. The code specification is determined by the pontic material rather than tooth position. While titanium pontics are frequently selected for posterior applications due to their superior strength and longevity, the final choice should be based on clinical assessment and individual patient requirements.
What are the specific contraindications for utilizing a titanium pontic under code D6212?
Contraindications for titanium pontic placement (D6212) include patients with documented titanium hypersensitivity, inadequate anatomical space for proper pontic placement, or aesthetic considerations in prominent smile zones where tooth-colored materials would be more appropriate. Each case requires individual patient evaluation with thorough documentation of any contraindications in the patient's clinical record.
What is the proper protocol when insurance companies downgrade D6212 to a base metal pontic regarding patient financial obligations?
When insurance carriers downgrade D6212 to a base metal pontic code, patients typically become responsible for the cost differential. Dental practices should inform patients of this potential scenario prior to treatment initiation, secure written informed consent regarding financial obligations, and clearly explain insurance policy limitations and available appeal procedures. Proactive communication prevents billing disputes and ensures patients understand their potential financial commitment.