D2391 - Resin (1 Surf Post)
Resin composite - 1 surface, posterior.
- Procedure Code
- D2391
- Category
- Restorative
Insurance Verification Benchmarks & Billing Guidelines
Benchmark Policy Source: Delta Dental National / PPO Standard
- Frequency Limitation
- Once per tooth surface every 24 consecutive months (ROLLING_MONTHS)
- Age Limitation
- All ages covered.
- Downgrade Policy Warning
- Many PPO plans downgrade posterior composite restorations to amalgam allowance (D2140). Patient pays the difference.
Required Claim Attachments & Pre-Submission Checklist
- Specific tooth number and surface (e.g. #19-O) indicated on claim
- Pre-operative radiograph demonstrating caries penetration into dentin
Bill When (Allowable Clinical Criteria)
- Treatment of initial caries or replacement of failed restoration on posterior tooth surface (O, B, L)
Restrictions & Clinical Exclusions
- Do NOT bill replacement of same surface within 24 months by same dentist
Common Claim Denial Codes & Overturn Strategies
| Denial Code | Denial Reason | Appeal & Overturn Strategy |
|---|---|---|
| CO-119 | Restoration billed within 24-month replacement period | Submit narrative detailing recurrent caries or fracture of remaining tooth structure. |
ICD-10 Justification & Crosswalk Mappings
| ICD-10 Code | Diagnosis Name | Category | Primary Justification | Claim Type | Clinical Scenario |
|---|---|---|---|---|---|
| K02.52 | Dental caries on pit and fissure surface penetrating into dentin | Dental caries | Yes (Primary) | BOTH | resin-based composite – one surface, posterior indicated for Dental caries on pit and fissure surface penetrating into dentin |
| K02.51 | Dental caries on pit and fissure surface limited to enamel | Dental caries | Secondary | BOTH | resin-based composite – one surface, posterior indicated for Dental caries on pit and fissure surface limited to enamel |
| K02.53 | Dental caries on pit and fissure surface penetrating into pulp | Dental caries | Secondary | BOTH | resin-based composite – one surface, posterior indicated for Dental caries on pit and fissure surface penetrating into pulp |
| K02.61 | Dental caries on smooth surface limited to enamel | Dental caries | Secondary | BOTH | resin-based composite – one surface, posterior indicated for Dental caries on smooth surface limited to enamel |
| K02.62 | Dental caries on smooth surface penetrating into dentin | Dental caries | Secondary | BOTH | resin-based composite – one surface, posterior indicated for Dental caries on smooth surface penetrating into dentin |
| K02.63 | Dental caries on smooth surface penetrating into pulp | Dental caries | Secondary | BOTH | resin-based composite – one surface, posterior indicated for Dental caries on smooth surface penetrating into pulp |
| K02.7 | Dental root caries | Dental caries | Secondary | BOTH | resin-based composite – one surface, posterior indicated for Dental root caries |
| K03.1 | Abrasion of teeth | Other diseases of hard tissues of teeth | Secondary | BOTH | resin-based composite – one surface, posterior indicated for Abrasion of teeth |
| K03.2 | Erosion of teeth | Other diseases of hard tissues of teeth | Secondary | BOTH | resin-based composite – one surface, posterior indicated for Erosion of teeth |
| K03.81 | Cracked tooth | Other diseases of hard tissues of teeth | Secondary | BOTH | resin-based composite – one surface, posterior indicated for Cracked tooth |
| S02.5XXA | Fracture of tooth (traumatic), initial encounter for closed fracture | Fracture of skull and facial bones | Secondary | BOTH | resin-based composite – one surface, posterior indicated for Fracture of tooth (traumatic), initial encounter for closed fracture |