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CDT code D2949: Expanded coverage and clarification

Q4 Word of Mouth newsletter 2025

The American Dental Association (ADA) introduced CDT code D2949 in 2021 to help close a documentation and billing gap in restorative dentistry, specifically for procedures involving indirect restorations. We expanded our dental benefits to include D2949 under many of our dental plans effective Jan. 1, 2024.

 

D2949 enables more precise coding in scenarios where:

  • A foundational restoration is needed but does not qualify as a traditional core buildup
  • Structural support is required prior to placing an indirect restoration, without the use of pins or extensive buildup techniques

 

D2949 overview

Providers can bill D2949 independently, helping to ensure fair compensation for clinical work performed.

 

D2949 is designated for cases where restorative material is placed to recreate the ideal preparation form of a tooth for placement of an indirect restoration. It applies when:

  • The tooth has minor structural irregularities
  • The preparation still provides adequate resistance and retention form

 

D2949 compared to D2950

Historically, many providers have used D2950 (core buildup) even when clinical conditions didn’t fully meet the criteria. This has led to inconsistencies in coding and reimbursement.

Clinical scenario D2949 restorative foundation D2950 core buildup
Cusp damage or loss Minor cusp damage with sufficient axial wall support. Material is used to stabilize or recreate anatomy Extensive cuspal loss often extends to the gingival margin and compromises integrity in the tooth
Caries removal Isolated voids or undercuts that interfere with crown seating Multiple axial walls are affected with significant structural compromise
Fracture lines Minimal excavation with adequate remaining tooth bulk. Material supports weak spots Deep fractures involving pulpal floor. Extensive loss of tooth structure and internal resistance compromised
Wall irregularities Reshaping for crown fit to fill minor undercuts or defects Part of broader decay or destruction requiring an extensive restoration
Restoration replacement Used to improve seal or bonding surface before placing the indirect restoration (usually limited to 1 or 2 surface replacement filling) Applies if multiple restorations  are replaced or additional defects exist (such as filling an endodontic access opening)

Clinical and billing implications

If documentation does not establish medical necessity for a D2950, benefits may instead be applied under D2949 provided the documentation supports its use. This offers an effective alternative to align with clinical intent while providing a benefit to the member and provider for the work completed. 

 

To ensure accurate claims processing:

  • Clearly document the clinical rationale for using D2950, distinctly differentiating it from D2949
  • Provide detailed documentation that supports correct coding, which aligns with UnitedHealthcare Clinical Guidelines and improves reimbursement outcomes
  • Submit a narrative and radiograph, which are required for code review
  • Include optional intraoral photographs to help further validate the clinical necessity and strengthen the overall claim

PCA-25-02387-DHV-EM_111125

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