When is D6251 used?
The D6251 dental code applies to pontics constructed from resin material with a predominantly base metal framework. This CDT code is specifically designated for fixed partial dentures (bridges) where the replacement tooth (pontic) combines resin material with a base metal foundation. Dental professionals should apply D6251 when treating edentulous areas with bridge restorations using this particular material combination, distinguishing it from all-ceramic, full-metal, or porcelain-fused-to-metal options. Correct code application facilitates proper claim processing and payment.
D6251 Charting and Clinical Use
Comprehensive documentation supports successful billing and regulatory compliance. When applying D6251, maintain detailed clinical records that include:
The edentulous location being treated (specific tooth numbers)
The pontic material composition (resin with base metal framework)
Pre-treatment and post-treatment radiographs or clinical photographs
Patient's treatment requirements and justification for material selection
Typical clinical applications for D6251 involve patients seeking economical bridge options or individuals with particular material sensitivities. Document all medical requirements or patient-related factors that guided the selection of resin-based pontic materials.
Billing and Insurance Considerations
To optimize payment and reduce claim rejections when submitting D6251:
Confirm benefits: Validate patient insurance coverage for fixed partial dentures and resin-based pontics through thorough benefit verification.
Provide supporting materials: Include clinical documentation, radiographic images, and detailed explanations regarding treatment necessity and material choice.
Apply accurate CDT codes: Use D6251 exclusively for resin with base metal pontics. For alternative materials, select the proper CDT code, such as D6240 for porcelain bonded to high noble metal.
Monitor EOBs carefully: Examine Explanation of Benefits documents for payment correctness and rejection explanations. When claims are denied, develop appeals with supplementary documentation.
Effective dental practices create systems for pre-treatment authorizations, efficient claim processing, and active accounts receivable management to secure timely compensation for D6251 treatments.
How dental practices use D6251
Practice Example: A 56-year-old patient arrives with an absent mandibular first molar. Following treatment option discussions, the dentist suggests a three-unit bridge featuring a resin-based pontic considering the patient's financial constraints and slight metal allergy. The clinical team records the missing tooth area, material choice reasoning, and initial radiographs. Benefit verification establishes D6251 coverage. The claim submission includes comprehensive supporting materials, resulting in timely payment processing. This example demonstrates the value of complete documentation, appropriate code usage, and effective insurance coordination when processing D6251 claims.
Common Questions
Is D6251 applicable for bridges made with materials other than porcelain fused to predominantly base metal?
No, D6251 is exclusively designated for pontics constructed from porcelain fused to predominantly base metal. When alternative materials are utilized, such as all-ceramic restorations or porcelain fused to high noble metal, the appropriate corresponding CDT code must be selected to ensure accurate material representation and proper claim processing.
Do most dental insurance plans have frequency restrictions or waiting periods for D6251?
Most dental insurance plans establish frequency restrictions or waiting periods for fixed bridge procedures, including those coded as D6251. Typical limitations include coverage eligibility once every 5-7 years per tooth location or mandatory waiting periods of 6-12 months following policy activation. It is essential to verify the patient's specific coverage details prior to treatment initiation.
What information should be provided in a narrative when filing a D6251 claim?
A comprehensive narrative for D6251 should articulate the clinical justification for the pontic placement, explain the rationale for selecting porcelain fused to base metal material, and reference supporting clinical documentation including radiographs and photographs. The narrative should detail the edentulous site characteristics, abutment tooth condition, and pertinent patient medical or dental history to support claim approval.