D2954 - Post and Core (Prefab)
Prefabricated post and core.
- Procedure Code
- D2954
- 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)
- A prefabricated post and core is a benefit in anterior teeth only when there is insufficient tooth structure to support a cast restoration.
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.
- A prefabricated post and core in addition to crown is a benefit only on an endodontically treated tooth. Fees for post and core are not billable to the patient when radiographs indicate an absence of endodontic treatment, or an incompletely filled canal space, or unresolved pathology associated with the involved tooth. Unresolved radiolucencies may be a reason to not billable to the patient but should be evaluated based on the time since the completion of the endodontic services and co-joint signs and symptoms.
- When radiographs indicate more than half of the coronal tooth structure remains, fees for post and cores are denied.
- 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 Justification & Crosswalk Mappings
| 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 post and core in addition to crown 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 post and core in addition to crown 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 post and core in addition to crown 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 post and core in addition to crown 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 post and core in addition to crown 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 post and core in addition to crown indicated for Fracture of tooth (traumatic), initial encounter for closed fracture |