D2928 - Crown (Porc Perm)
Prefabricated porcelain crown - permanent tooth.
- Procedure Code
- D2928
- Clinical Category
- Restorative
- Primary ICD-10 Justification
- K02.63 (Dental caries on smooth surface penetrating into pulp)
- Reference Fee & Claim Types
- BOTH
Insurance Verification Benchmarks & Billing Guidelines
Payer policy benchmarks, pre-submission attachment requirements, and denial prevention rules for D2928.
- Frequency Limitation
- Subject to group/individual contract frequency limitations (none)
Required Claim Attachments & Pre-Submission Checklist
- Standard ADA claim form with CDT procedure code and date of service
Bill When (Allowable Clinical Criteria)
- Indicated for medically and clinically necessary treatment as documented in patient's dental record.
Restrictions & Clinical Exclusions
- The fees for buildups are not billable to the patient when buildups are performed in conjunction with inlays, ¾ crowns or onlays.
- Fees for repairs are not billable to the patient within 24 months of the original restoration by the same dentist/dental office. Benefits are denied if done by a different dentist/dental office.
- The fee for the replacement of a prefabricated porcelain/ceramic crown by the same dentist/dental office within 24 months is included in the initial crown placement and is not billable to the patient.
- Benefits for D2928 are denied if done by different dentist/dental office within 24 months.
- 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.
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. |
ICD-10-CM Justification & Crosswalk Mappings for D2928 (6)
Click any ICD-10-CM diagnosis code below to inspect its reverse procedure mappings and differential coding guide.
| ICD-10 Code | Diagnosis Name | Category | Primary Justification | Claim Type | Clinical Scenario |
|---|---|---|---|---|---|
| K02.63 | Dental caries on smooth surface penetrating into pulp | Dental caries | ★ Yes (Primary) | BOTH | prefabricated porcelain/ceramic crown – permanent tooth indicated for Dental caries on smooth surface penetrating into pulp |
| K00.2 | Abnormalities of size and form of teeth | Disorders of tooth development and eruption | Secondary | BOTH | prefabricated porcelain/ceramic crown – permanent tooth indicated for Abnormalities of size and form of teeth |
| K02.52 | Dental caries on pit and fissure surface penetrating into dentin | Dental caries | Secondary | BOTH | prefabricated porcelain/ceramic crown – permanent tooth indicated for Dental caries on pit and fissure surface penetrating into dentin |
| K02.53 | Dental caries on pit and fissure surface penetrating into pulp | Dental caries | Secondary | BOTH | prefabricated porcelain/ceramic crown – permanent tooth indicated for Dental caries on pit and fissure surface penetrating into pulp |
| K02.62 | Dental caries on smooth surface penetrating into dentin | Dental caries | Secondary | BOTH | prefabricated porcelain/ceramic crown – permanent tooth indicated for Dental caries on smooth surface penetrating into dentin |
| S02.5XXA | Fracture of tooth (traumatic), initial encounter for closed fracture | Fracture of skull and facial bones | Secondary | BOTH | prefabricated porcelain/ceramic crown – permanent tooth indicated for Fracture of tooth (traumatic), initial encounter for closed fracture |
Frequently Asked Questions — D2928 (Crown (Porc Perm))
Quick answers for dental billers and treatment coordinators submitting claims for D2928.
What ICD-10 diagnosis codes link to dental procedure D2928?▾
Common ICD-10-CM justification codes for CDT D2928 (Crown (Porc Perm)) include: K02.63 - Dental caries on smooth surface penetrating into pulp (Primary); K00.2 - Abnormalities of size and form of teeth; K02.52 - Dental caries on pit and fissure surface penetrating into dentin; K02.53 - Dental caries on pit and fissure surface penetrating into pulp; K02.62 - Dental caries on smooth surface penetrating into dentin; S02.5XXA - Fracture of tooth (traumatic), initial encounter for closed fracture.
Can CDT code D2928 be billed to medical insurance?▾
Billing CDT D2928 (Crown (Porc Perm)) to medical insurance depends on the underlying clinical necessity and trauma/pathology documentation. Supported claim types across linked diagnoses: BOTH.
What attachments and documentation are required for billing CDT D2928?▾
Required claim attachments for CDT D2928 (Crown (Porc Perm)) include: Standard ADA claim form with CDT procedure code and date of service.
What is the insurance frequency limitation for CDT D2928?▾
Standard commercial insurance frequency for D2928: Subject to group/individual contract frequency limitations (none).
What are common insurance denial reasons and appeal tips for CDT D2928?▾
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.