CurrentCareFirstPolicy N/A

Comprehensive dental restorative services (CDT D2000-D2999)

Guidance for coding, coverage expectations, frequency limits, and documentation requirements for restorative dental CDT codes D2000-D2999 for CareFirst members and participating programs.

Policy Summary

PayerCareFirst

PolicyComprehensive dental restorative services (CDT D2000-D2999)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionObtain a pre-treatment estimate with required radiographs and rationale for many indirect restorations and crowns.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

D2000-D2999CDT code range covered

12 monthsFrequency - many restorations

5 yearsFrequency - crowns/onlays

50%Minimum bone support

Selected codesClinical review required

Coverage Criteria — Restorative Services (D2000-D2999)

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Direct restorations (amalgam and resin-based composites)

Covered when ALL of the following are met for routine direct restorations:

Direct restoration frequency and surfaces: Restoration is for a primary or permanent tooth; benefits are typically available once per 12 months per surface; when multiple restorations are reported on contiguous surfaces of the same tooth, surfaces will be combined for an allowable multi-surface benefit; multiple non-contiguous restorations are paid individually.once per 12 months per surface

Indirect pulp caps (D3120) are considered inclusive to the restoration

Indirect restorations, inlays/onlays, crowns

Covered when ALL of the following are met for indirect restorations, inlays, onlays, and crowns:

Indirect restoration clinical criteria: Limited to permanent teeth; procedure required due to extensive caries or trauma; a direct restoration is not feasible; patient may have documented allergy to direct restorative materials when applicable; tooth free of endodontic signs/symptoms; tooth must present with a minimum of 50% bone support; benefits typically available once every five years per tooth.once every five years per tooth / minimum 50% bone support

Pre-treatment estimate and clinical review recommended; pre-operative periapical radiographs and intraoral photos recommended; post-operative radiograph required for endodontically treated teeth

Typically not covered

Not covered or restricted:

Gold foil codes (D2410-D2430) are typically not covered.n/a

Typically not covered

General criteria for indirect restorations and crowns

Covered when ALL of the following are met (applies to many indirect restorations, crowns, onlays, veneers, prefabricated permanent crowns):

Base eligibility: Procedure is for a permanent tooth (when specified) and must be required due to extensive caries or trauma; a direct restoration must be infeasible.

Check patient eligibility, age and plan frequency limits

Endodontic status: Tooth must be free of endodontic signs/symptoms; for endodontically treated teeth a post-operative periapical radiograph is required.

Post-op radiograph required for many post-and-core codes

Support requirement: Tooth must present with a minimum of 50% bone support to be eligible for many indirect restorations.>=50% bone support

Criteria for core buildup and post-and-core procedures

Covered when ALL of the following are met (core build-up and post-and-core related codes):

Indication: A significant amount of tooth structure is missing such that retention of the final restoration is not possible (indication for D2950 core buildup).

Paired services: Core buildup and post-and-core services are not payable if submitted with direct restorations on the same tooth; certain post codes (e.g., D2953) are only payable when submitted with their companion code (e.g., D2952).

Frequency & review: If covered, benefits for core buildup and post-and-core procedures are typically available once every five years per tooth; clinical review and pre-treatment estimate recommended; post-operative periapical radiograph showing completed root canal required for many post procedures.Once every 5 years

Post-op radiograph required for many post-and-core codes (D2952, D2953, D2954, D2957)

Inclusive / non-billable procedures

Coverage stance for interim, foundation, and inclusive services:

Inclusive services: D2949 (restorative foundation) and D2799 (provisional crown) are considered inclusive to the definitive restoration and are not billable to CareFirst or the member; D2940 (placement of interim direct restoration) is typically benefitable once per tooth per year but will be denied if billed with another restoration, direct/indirect pulp cap, or endodontic therapy.

Protective interim restorations billed with qualifying services will be denied as inclusive

Per-code coverage criteria

Coverage stance and limits for specific codes within D2000-D2999

D2971: Covered when clinically necessary; typically available once every five years per tooth.frequency: once every 5 years per tooth

Requires clinical review if performed on a primary tooth; pre-operative periapical radiograph, rationale and date of prior placement required; post-op radiograph for endodontically treated teeth

D2975: Coping (D2975) is covered as required; approval depends on plan frequency limits.none

No documentation typically required

D2976: Band stabilization per tooth (D2976) is considered inclusive to the permanent restoration and not separately billable.none

Gold foil restorations (CDT codes D2410–D2430) are typically not covered by CareFirst. The policy lists these codes specifically as not covered and provides no supporting documentation requirements for approval.

Prefabricated porcelain/ceramic crown for a primary tooth (D2929) is typically not covered. Prefabricated crown codes for primary and permanent teeth (for example, D2930 and D2931) may be eligible when clinically indicated for extensive caries or trauma, limited to the applicable age groups and subject to frequency limits (commonly once every five years for crowns on qualifying teeth). Clinical review and pre-treatment documentation (pre-operative periapical radiograph, rationale and date of prior placement; intraoral photo recommended) are required for many indirect restorations and related procedures.

The following CDT codes are listed as typically not covered: D2981 (inlay repair), D2982 (onlay repair), D2983 (veneer repair), D2990 (resin infiltration), and D2991 (application of hydroxyapatite regeneration medicament).

Indirect restorations (inlays, onlays, crowns) that do not meet the policy's clinical criteria are not eligible for coverage. Common examples include situations where a direct restoration is feasible, the tooth lacks adequate support (the policy requires the tooth to present with a minimum of 50% bone support for many indirect restorations), or the tooth exhibits active endodontic signs/symptoms. Repairs of indirect restorations due to restorative material failure (D2981–D2983) and novel medicament applications (D2990, D2991) are specifically identified as typically not covered and therefore considered not medically necessary under standard coverage.

Repair procedures and newer or novel treatments are generally limited in coverage. Crown repair (D2980) may be allowed (typically once per tooth every 12 months) subject to plan frequency limits, but inlay/onlay/veneer repairs (D2981–D2983) are listed as typically not covered. Resin infiltration (D2990) and hydroxyapatite regeneration medicament application (D2991) are also typically not covered. When coverage is uncertain or an unspecified restorative code is used (D2999), a narrative clinical review is required.

Repairs of inlays, onlays and veneers (codes D2981, D2982, D2983) are designated as typically not covered, with no documentation pathway for coverage listed. The rationale in the policy identifies these services as restorative repair procedures that are excluded from benefit under standard coverage. By contrast, certain other restoration-related services (for example, crown repairs D2980 or excavation determining non-restorability D2989) have defined frequency limits or documentation requirements when they are eligible for benefit.

Coding — CDT Codes, Frequencies and Limits

Common direct restorative codesCPTCovered

D2140	Amalgam-one surface, primary or permanent
D2150	Amalgam-two surfaces, primary or permanent
D2160	Amalgam-three surfaces, primary or permanent
D2161	Amalgam-four or more surfaces, primary or permanent
D2330	Resin-based composite-one surface, anterior
D2331	Resin-based composite-two surfaces, anterior
D2332	Resin-based composite-three surfaces, anterior
D2335	Resin-based composite-four or more surfaces
D2390	Resin-based, composite crown- anterior
D2391	Resin-based, composite, one surface-posterior

1–10 of 13

1/2

Indirect restorations, inlays/onlays, crowns and gold foilCPT

D2410	Gold foil-one surface
D2420	Gold foil-two surfaces
D2430	Gold foil-three surfaces
D2510	Inlay-metallic-one surface
D2520	Inlay-metallic-two surfaces
D2530	Inlay-metallic-three surfaces
D2542	Onlay metallic-two surfaces
D2543	Onlay metallic-three surfaces
D2544	Onlay metallic-four or more surfaces
D2610	Inlay-porcelain/ceramic-one surface

1–10 of 25

1/3

Restorative CDT Codes (D2000-D2999)CPT

D2664	Onlay-Resin-based composite-four or more surfaces
D2710	Crown-resin-based composite (indirect)
D2712	Crown-3/4 resin-based composite (indirect)
D2720	Crown-resin with high noble metal
D2721	Crown-resin with predominantly base metal
D2722	Crown-resin with noble metal
D2740	Crown-porcelain/ceramic
D2750	Crown-porcelain fused to high noble metal
D2751	Crown-porcelain fused to predominantly base metal
D2752	Crown-porcelain fused to noble metal

1–10 of 55

1/6

Typically not covered / limitedCPTNot Covered

D2929	Prefabricated porcelain/ceramic crown-primary tooth
D2981	Inlay repair-necessitated by restorative material failure
D2982	Onlay repair-necessitated by restorative material failure
D2983	Veneer repair-necessitated by restorative material failure
D2990	Resin infiltration of incipient smooth surface lesions
D2991	Application of hydroxyapatite regeneration medicament-per tooth

Restorative CDT Codes D2000-D2999mixed

D2971	Additional procedures to construct new crowns under existing partial denture framework
D2975	Coping
D2976	Band stabilization-per tooth
D2980	Crown repair-necessitated by restorative material failure
D2981	Inlay repair-necessitated by restorative material failure
D2982	Onlay repair-necessitated by restorative material failure
D2983	Veneer repair-necessitated by restorative material failure
D2989	Excavation of a tooth resulting in the determination of non-restorability
D2990	Resin infiltration of incipient smooth surface lesions
D2991	Application of hydroxyapatite regeneration medicament-per tooth

1–10 of 11

1/2

Frequency per surface

FrequencyTypically once per 12 months per surface

Contiguous surfacesWhen multiple restorations are reported on contiguous surfaces of the same tooth, CareFirst will combine surfaces for an allowable benefit

DocumentationNo documentation required for many one- to four-surface restorative codes unless plan frequency limits apply

Interval for inlays/onlays/crowns

IntervalTypically once every five years per tooth

Tooth typeLimited to permanent teeth for most inlays/onlays/crowns

IndicationProcedure must be required due to extensive caries or trauma and direct restoration must be not feasible

Tooth support requirement

RequirementTooth must present with a minimum of 50% bone support for coverage of many indirect restorations

Endodontic statusTooth must be free of endodontic signs/symptoms; post-op radiograph required if endodontically treated

Clinical reviewMany indirect restorations require pre-treatment clinical review, radiographs, and sometimes intraoral photos

Minimum bone support

>= Bone support>= 50%

ContextMinimum requirement applies to many crowns, onlays, veneers and related indirect restorations

VerificationPre-operative periapical radiograph and intraoral photo recommended to demonstrate need

Frequency for many crowns/onlays/veneers/prefabricated crowns/core/build-up/post

FrequencyOnce every 5 years per tooth (when covered)

Applies toMany crowns, onlays, veneers, prefabricated crowns, core build-ups and post-and-core when covered

NoteCheck plan-specific age and frequency limitations; pre-treatment estimate recommended for many of these services

Recement/repair frequency

Recement/repair frequencyTypically once every 12 months per tooth (some recements not payable until restoration has been in place for six months)

ExamplesD2910, D2915, D2920 typically allowed once in a 12-month period but not until after the restoration has been in place for six months

DocumentationNo documentation is required for many recement procedures; approval depends on plan frequency limits

Provider Actions — Documentation, Pre-treatment Review and Authorization

Prior Authorization

Prior authorization for D2971

D2971 typically requires prior authorization and is limited to once every five years per tooth. When performed on a primary tooth it requires clinical review. Submit a pre-operative periapical radiograph, rationale and date of prior placement. For endodontically treated teeth include a post-operative periapical radiograph. Intraoral photos are recommended to demonstrate clinical need.

D2971: prior authorization may be required; benefits typically available once every five years per tooth.
Required imaging: pre-operative periapical radiograph, rationale and date of prior placement; post-operative periapical radiograph if endodontically treated; intraoral photo recommended.

Denial Risk

Pre-treatment review denials

Failure to submit required pre-treatment review materials (radiographs, photos, narratives or pre-treatment estimate) for procedures that specify them may result in denial of the claim. Providers should include all requested supporting documentation at time of pre-treatment estimate or prior authorization to avoid delay or denial.

Applicable to many indirect restorations, crowns, onlays, veneers, prefabricated permanent crowns, cores and post procedures.
Commonly requested items: pre-operative periapical radiograph, rationale and date of prior placement, intraoral photos, and post-operative radiographs for endodontically treated teeth.

Billing Rule

Inclusive service not billable

Procedures or service components that are considered inclusive to another billed service are not separately payable. Do not bill inclusive services in addition to the associated primary restoration.

D2949 (restorative foundation for an indirect restoration) is considered inclusive and not billable.
D2940 (protective/interim restoration) will be denied if billed with another restoration, direct/indirect pulp cap, or endodontic therapy.

Denial Risk

Denial for non-covered procedure descriptions

If the service performed is not a covered procedure (by description), the claim will be denied with a specific reason. For unspecified or unusual treatments, include a clear narrative explaining why an existing CDT code does not accurately represent the treatment performed.

D2999 (unspecified restorative procedure) requires a narrative describing the clinical presentation and why no existing code captures the treatment.
When a procedure description corresponds to a non-covered service, expect a denial with the applicable non-coverage reason.

Documentation Required

Post-op radiograph requirement for posts

Post-operative periapical radiographs are required for post-and-core procedures to document completion of endodontic therapy and proper post placement.

D2952, D2953, D2954, D2957: submit post-operative periapical radiograph showing the completed root canal.
Post-op radiograph supports clinical review and is frequently required with pre-treatment estimates for these codes.

Documentation Required

D2971 documentation

D2971 documentation requirements: clinical review when on a primary tooth; pre-operative periapical radiograph, rationale and date of prior placement; post-operative periapical radiograph for endodontically treated teeth; intraoral photo recommended.

Ensure prior authorization is obtained when plan requires it and include all imaging and rationale to support medical necessity.
Benefits generally limited to once every five years per tooth.

Billing Rule

D2976 documentation

D2976 is considered inclusive to the permanent restoration and is not separately payable; no additional documentation is required.

D2976 (band stabilization-per tooth) is inclusive to the permanent restoration and should not be billed separately.
Approval for permanent restoration remains subject to plan frequency limits and clinical criteria.

Documentation Required

D2989 documentation

D2989 requires clinical review when performed on a primary tooth. Submit a pre-operative periapical or bitewing radiograph and include intraoral photos to demonstrate need.

D2989 (excavation determining non-restorability) is typically allowed once per lifetime per tooth.
When on a primary tooth, clinical review is required; include radiographs and recommended photos.

Documentation Required

D2999 documentation

D2999 requires clinical review with a narrative describing the clinical presentation and the specific treatment that is not adequately captured by an existing CDT code. If the described procedure is non-covered, the claim will be denied with the appropriate reason.

Provide a detailed narrative explaining why no existing code applies and include supporting radiographs and photos when applicable.
Expect clinical review and potential denial if the service description indicates a non-covered procedure.

Definitions and Policy Terms

Contiguous surface combining

PolicyWhen multiple restorations are reported on contiguous surfaces of the same tooth, CareFirst will combine surfaces for an allowable benefit

ExampleTwo contiguous one-surface restorations may be allowed as a multi-surface code (e.g., D2140 + D2140 → D2150)

Non-contiguousMultiple restorations billed for non-contiguous surfaces will be paid individually

Clinical review required

Clinical reviewCertain indirect restorations require pre-treatment clinical review and a pre-treatment estimate is recommended

ImagingPre-operative periapical radiograph and intraoral photos recommended; post-operative periapical radiograph required for endodontically treated teeth

Codes often requiring reviewMany inlay/onlay and crown codes list 'Requires clinical review; pre-treatment estimate recommended' in supporting documentation

Minimum bone support

Minimum supportTooth must present with a minimum of 50% bone support to be eligible for benefits for many restorative procedures

Applies toMany crowns, onlays, veneers, prefabricated permanent crowns and related indirect restorations

VerificationClinical and radiographic evidence (pre-op periapical radiograph, intraoral photo) recommended to document support

Inclusive service

Inclusive servicesCertain preparatory or interim procedures (e.g., D2949 restorative foundation, D2799 provisional crown) are considered inclusive to the definitive restoration and are not billable

Protective restorationD2940 (placement of interim direct restoration) is typically allowed once per tooth per year but will be denied as inclusive if billed with another restoration, pulp cap, or endodontic therapy

BillingInclusive procedures should not be billed separately to CareFirst or the member

D2971

D2971Additional procedures to construct new crowns under existing partial denture framework; typically limited to once every five years per tooth

DocumentationRequires clinical review if performed on a primary tooth; pre-op periapical radiograph, rationale and date of prior placement; post-op radiograph for endodontically treated teeth; intraoral photo recommended

EligibilityOnly payable if the tooth qualifies for full crown coverage based on clinical necessity

D2975

D2975Coping; benefit available as required; no documentation typically required

ApprovalApproval depends on plan frequency limits

BillingNo special documentation usually needed to support this code

D2976

D2976Band stabilization per tooth; considered inclusive to the permanent restoration

DocumentationNo documentation required (listed as n/a)

BillingNot billable separately when rendered as part of the definitive restoration

D2980

D2980Crown repair necessitated by restorative material failure; typically allowed once per tooth every 12 months

DocumentationNo documentation required; approval depends on plan frequency limitations

LimitOnce per tooth every 12 months is the typical frequency when covered

D2981, D2982, D2983

Coverage stanceD2981, D2982, D2983 (inlay/onlay/veneer repairs for restorative material failure) are typically not covered

DocumentationSupporting documentation listed as n/a for these codes

ImplicationThese repair codes are generally excluded and claims will typically be denied

D2989

D2989Excavation resulting in determination of non-restorability; typically available once per lifetime per tooth

DocumentationRequires clinical review if performed on a primary tooth; pre-operative periapical or bitewing radiograph; intraoral photo recommended

LimitOnce per lifetime per tooth is the typical allowance

D2990, D2991

CoverageD2990 and D2991 (resin infiltration and hydroxyapatite regeneration medicament applications) are typically not covered

DocumentationSupporting documentation listed as n/a

ImplicationThese novel or preventative procedures are generally excluded from coverage

D2999

D2999Unspecified restorative procedure by report; requires clinical review with narrative describing why an existing CDT code does not accurately represent the treatment

Denial riskIf the described procedure is not covered, it will be denied with a specific reason

DocumentationNarrative clinical review required to support coverage consideration

Background: Restorative CDT codes D2000–D2999 encompass routine direct restorations (amalgam and resin-based composites), inlays/onlays, crowns, provisional and prefabricated crowns, core build-ups and post-and-core procedures. The policy distinguishes between routine direct restorations—typically subject to frequency limits such as once per 12 months per surface—and more complex indirect restorations, which are generally limited to permanent teeth, required because a direct restoration is not feasible, and frequently limited to once every five years per tooth when covered. Many indirect procedures require clinical review and supporting radiographs or intraoral photos.

OpenPayer

Comprehensive dental restorative services (CDT D2000-D2999)

Coverage Criteria — Restorative Services (D2000-D2999)

Coding — CDT Codes, Frequencies and Limits

Provider Actions — Documentation, Pre-treatment Review and Authorization

Definitions and Policy Terms

Background and Scope

Revision History