D2420ADA CDT ProcedureRestorativeGOLD FOIL RESTORATIONS

D2420 - Gold Foil (2 Surf)

Gold foil - two surfaces.

Patient-Friendly Summary: A precision gold foil restoration placed across two surfaces of a tooth to provide an airtight, biocompatible seal. It protects against recurrent decay and offers exceptional durability for decades.
Clinical Documentation Notes: Not a covered benefit.
Procedure Code
D2420
Clinical Category
Restorative
Primary ICD-10 Justification
See mapped diagnoses below
Reference Fee & Claim Types
DENTAL

Insurance Verification Benchmarks & Billing Guidelines

Payer policy benchmarks, pre-submission attachment requirements, and denial prevention rules for D2420.

Source: Delta Dental 2026
Frequency Limitation
Subject to group/individual contract frequency limitations (none)

Required Claim Attachments & Pre-Submission Checklist

  • Diagnostic pre-operative radiograph showing affected tooth/area

Bill When (Allowable Clinical Criteria)

  • An alternate benefit will be allowed for an amalgam or resin restoration, according to the policies for amalgam and resin restorations. The additional fee up to the approved amount for the gold foil restoration is chargeable to the patient.

Restrictions & Clinical Exclusions

  • Infection control is included in the fee for the dental services provided. Separate fees are not billable to the patient.
  • Benefits for restorations for altering occlusion, adjusting vertical dimension, replacing tooth structure lost by attrition, erosion, abrasion, abfraction, corrosion, TMD or for periodontal, orthodontic or other splinting are denied, unless covered by group/individual contract.
  • Benefits for biomimetic restorations (e.g. Biodentine) are denied as investigational.
  • For benefit purposes, local anesthesia is an integral part of the procedure being performed and additional fees are not billable to the patient.
  • The fee for a restoration includes services such as, but not limited to, adhesives, etching, liners, bases, direct and indirect pulp caps, local anesthesia, polishing, occlusal adjustment, caries removal and gingivectomy on the same date of service. Fees for the procedures noted above, when performed in conjunction with a restoration, by the same dentist/dental office are not billable to the patient on the same date of service.
  • Fees for the replacement of amalgam or composite restorations within 24 months are not billable to the patient if done by the same dentist/dental office. Benefits may be allowed if done by a different dentist. Special consideration may be given by report.

Common Claim Denial Codes & Overturn Strategies

Denial CodeDenial ReasonAppeal & Overturn Strategy
CO-119Benefit maximum or frequency limitation exceeded for procedureSubmit clinical narrative detailing extraordinary circumstances, active recurrent pathology, or exception criteria.

ICD-10-CM Justification & Crosswalk Mappings for D2420 (0)

Click any ICD-10-CM diagnosis code below to inspect its reverse procedure mappings and differential coding guide.

No direct ICD-10 mappings recorded for D2420.

Frequently Asked Questions — D2420 (Gold Foil (2 Surf))

Quick answers for dental billers and treatment coordinators submitting claims for D2420.

What ICD-10 diagnosis codes link to dental procedure D2420?▾

Currently no specific ICD-10 crosswalk mappings recorded for CDT D2420.

Can CDT code D2420 be billed to medical insurance?▾

Billing CDT D2420 (Gold Foil (2 Surf)) to medical insurance depends on the underlying clinical necessity and trauma/pathology documentation. Supported claim types across linked diagnoses: DENTAL.

What attachments and documentation are required for billing CDT D2420?▾

Required claim attachments for CDT D2420 (Gold Foil (2 Surf)) include: Diagnostic pre-operative radiograph showing affected tooth/area.

What is the insurance frequency limitation for CDT D2420?▾

Standard commercial insurance frequency for D2420: Subject to group/individual contract frequency limitations (none).

What are common insurance denial reasons and appeal tips for CDT D2420?▾

Denial Code CO-119 (Benefit maximum or frequency limitation exceeded for procedure): Overturn appeal strategy - Submit clinical narrative detailing extraordinary circumstances, active recurrent pathology, or exception criteria.