D2940 - Interim Direct Res
Placement of interim direct restoration.
- Procedure Code
- D2940
- Category
- Restorative
Insurance Verification Benchmarks & Billing Guidelines
Benchmark Policy Source: Delta Dental 2026
- 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)
- Interim direct restorations are covered benefits for emergency relief of pain once per tooth.
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 an interim direct restoration is not billable to the patient when performed in conjunction with definitive dental treatment by same dentist/dental office on same date of service.
- Fees for D2940 are not billable to the patient when performed in conjunction with any restorative codes D2000-D2999, or bridge codes (D6200-D6699).
- Fees for D2940 are not billable to the patient when performed in conjunction with any endodontic code D3220-D3950. When a D2940 is benefitted, the fees for D3110 (pulp cap – direct) and D3120 (pulp cap – indirect) 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. |
ICD-10 Justification & Crosswalk Mappings
| ICD-10 Code | Diagnosis Name | Category | Primary Justification | Claim Type | Clinical Scenario |
|---|---|---|---|---|---|
| K02.9 | Dental caries, unspecified | Dental caries | Yes (Primary) | BOTH | placement of interim direct restoration indicated for Dental caries, unspecified |
| S02.5XXA | Fracture of tooth (traumatic), initial encounter for closed fracture | Fracture of skull and facial bones | Secondary | BOTH | placement of interim direct restoration indicated for Fracture of tooth (traumatic), initial encounter for closed fracture |