D6940 - Stress Breaker
Stress breaker.
- Procedure Code
- D6940
- Category
- Prosthodontics
Insurance Verification Benchmarks & Billing Guidelines
Benchmark Policy Source: Delta Dental 2026
- Frequency Limitation
- 1 per tooth/space in a 60-month interval (5 years) (rolling_12_months)
- Age Limitation
- Restricted to patients age 16 or older (complete skeletal development required).
Required Claim Attachments & Pre-Submission Checklist
- Pre-operative treatment narrative and clinical rationale
Bill When (Allowable Clinical Criteria)
- Indicated for medically and clinically necessary treatment as documented in patient's dental record.
Restrictions & Clinical Exclusions
- Fixed partial denture prosthetic procedures include the routine use of temporary prosthetics during the time for normal laboratory fabrication of the completed prosthesis. Participating dentists have agreed that these temporary prostheses are part of the fee for the fixed prosthetic device. Fees for interim or provisional appliances are not billable to the patient when reported less than six months prior to placement of the permanent prosthesis.
- For benefit purposes, anesthesia is an integral part of the procedures being performed and additional fees are not billable to the patient.
- A posterior fixed bridge and partial denture are not benefits in the same arch within the frequency limitations. Benefit is limited to the allowance for the partial denture.
- Fixed prosthodontics are not a benefit for children under 16 years of age. Benefits for children under age 16 are denied.
- Benefits for porcelain and resin inlay bridges are denied.
- The fees for indirectly fabricated restorations and prosthetic procedures include all models, temporaries, laboratory charges and materials, and other associated procedures. Any fees charged for these procedures by the same dentist/dental office in excess of the approved amounts for the indirectly fabricated restorations or prosthetic procedures are not billable to the patient on same date of service.
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 |
|---|