D2610 - Inlay (Porc 1 Surf)
Porcelain/ceramic inlay - one surface.
- Procedure Code
- D2610
- 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 D2610.
- Frequency Limitation
- 1 per tooth in a 60-month interval (5 years) (rolling_12_months)
- Age Limitation Criteria
- Restricted to patients age 12 or older. Crowns and onlays are denied for children under 12 years of age.
- Downgrade Policy Warning
- Inlay/onlay restoration is subject to LEPAT alternate benefit; payable as direct amalgam or composite restoration allowance.Alternate Code: D2140
Required Claim Attachments & Pre-Submission Checklist
- Diagnostic pre-operative radiograph showing affected tooth/area
- Pre-operative treatment narrative and clinical rationale
Bill When (Allowable Clinical Criteria)
- For inlay restorations, an alternate benefit will be allowed for an amalgam or resin restoration, according to the policies for amalgam and resin restorations. Any additional fee up to the approved amount for the inlay is chargeable to the patient.
Restrictions & Clinical Exclusions
- Crowns and onlays are not a benefit for children under 12 years of age. Benefits for patients under age 12 are denied.
- Restorative benefits are made for the least expensive professionally accepted treatment procedure (LEPAT). Any difference in the fee is denied.
- If the deciduous tooth is an “extra tooth” in addition to the normal complement of teeth, an inlay/onlay is not a benefit. Benefits are denied and the approved amount is chargeable to the patient.
- If an inlay/onlay is being proposed or has been done where periodontal bone support appears to be inadequate, benefits are denied due to the unfavorable prognosis for the tooth.
- Indirectly fabricated restorations include all models, temporaries and other associated procedures. Separate fees for models, temporaries, and other associated procedures by the same dentist/dental office 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.
Common Claim Denial Codes & Overturn Strategies
| Denial Code | Denial Reason | Appeal & Overturn Strategy |
|---|---|---|
| CO-119 | Benefit maximum or frequency limitation exceeded for procedure | Submit clinical narrative detailing extraordinary circumstances, active recurrent pathology, or exception criteria. |
| CO-96 | Non-covered charge / Downgraded under Least Expensive Professionally Accepted Treatment (LEPAT) | Submit clinical photographs and narrative documenting why the alternate benefit material is clinically contraindicated. |
ICD-10-CM Justification & Crosswalk Mappings for D2610 (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 D2610.
Frequently Asked Questions — D2610 (Inlay (Porc 1 Surf))
Quick answers for dental billers and treatment coordinators submitting claims for D2610.
What ICD-10 diagnosis codes link to dental procedure D2610?▾
Currently no specific ICD-10 crosswalk mappings recorded for CDT D2610.
Can CDT code D2610 be billed to medical insurance?▾
Billing CDT D2610 (Inlay (Porc 1 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 D2610?▾
Required claim attachments for CDT D2610 (Inlay (Porc 1 Surf)) include: Diagnostic pre-operative radiograph showing affected tooth/area; Pre-operative treatment narrative and clinical rationale.
What is the insurance frequency limitation for CDT D2610?▾
Standard commercial insurance frequency for D2610: 1 per tooth in a 60-month interval (5 years) (rolling_12_months). Age criteria: Restricted to patients age 12 or older. Crowns and onlays are denied for children under 12 years of age..
Does dental insurance downgrade CDT code D2610?▾
Inlay/onlay restoration is subject to LEPAT alternate benefit; payable as direct amalgam or composite restoration allowance.
What are common insurance denial reasons and appeal tips for CDT D2610?▾
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. | Denial Code CO-96 (Non-covered charge / Downgraded under Least Expensive Professionally Accepted Treatment (LEPAT)): Overturn appeal strategy - Submit clinical photographs and narrative documenting why the alternate benefit material is clinically contraindicated.