CurrentColorado Rocky Mountain Health PlansPolicy N/A

Other Restorative Dental Procedures (repair/recement/reattachment/coping)

Defines indications, coding, and guidance for repair, recementation, rebonding, reattachment of tooth fragments, and coping related to single-tooth indirect restorations for UnitedHealthcare dental plans; intended for providers determining coverage and billing. Member-specific benefit plan documents govern final coverage.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyOther Restorative Dental Procedures (repair/recement/reattachment/coping)

Policy CodePolicy N/A

Change TypeReference update (non-material)

Effective Date07/01/2025

Next Review DateN/A

Key ActionVerify member-specific benefit plan for coverage and any prior authorization requirements before providing or billing services.

SourceLink

POLICY UPDATE CHANGES

Updated References section to reflect the most current information and archived previous policy version DCP024.12.

DCP024.13internal id

9document chunks

11CDT codes

07/01/2025effective

Coverage Criteria

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Coverage criteria

Covered when the documented clinical indications below are met:

Repair/Recement/Rebond: These procedures are indicated for an Inlay, Onlay, Crown, or Laminate Veneer in which the functional area is involved due to restorative material failure or separation from original cement/bond.

Supports use of D2910/D2920/D2980–D2983 as appropriate.

Reattachment of Tooth Fragment: Reattachment of tooth fragment is indicated for a tooth fracture confined to enamel and dentin with loss of structure.

Not indicated for fractures involving tooth roots.

Coping Indications: Coping is considered inclusive to the preparation of a Crown and bridge Abutment Crowns unless a separate procedure is indicated when insufficient natural tooth structure remains to retain the Crown or to allow a common path of insertion when retainer teeth are tipped or misaligned.

Relates to code D2975.

Reattachment of a tooth fragment is indicated only when the fracture is confined to enamel and dentin with loss of structure. Reattachment of tooth fragment is not indicated for fractures involving tooth roots.

Applicable Codes

Applicable CDT Procedure Codes (reference list)CDT

D2910	Re-cement or re-bond inlay, onlay, veneer or partial coverage restoration.
D2915	Re-cement or re-bond indirectly fabricated or prefabricated post and core.
D2920	Re-cement or re-bond crown.
D2921	Reattachment of tooth fragment, incisal edge or cusp.
D2971	Additional procedures to construct a new crown to fit under existing partial denture framework.
D2975	Coping.
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.

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Provider Actions & Billing Guidance

Prior Authorization

Prior Authorization Determined by Member Plan

Coverage and any requirement for prior authorization are determined by the member-specific benefit plan document. This policy provides guidance only; always verify the member's plan for prior authorization requirements prior to delivering services.

Refer to the member specific benefit plan document for prior authorization determinations.

Note

Member-Specific Plan Governs Coverage

When deciding coverage for a service, reference the member-specific benefit plan document. In the event of any conflict between this policy and the member-specific benefit plan, the member-specific benefit plan governs.

Member-specific plan terms override this guidance when conflicts exist.

Denial Risk

Coverage Contingent on Member Benefit

Listing of a code in this guideline does not imply that the service described by the code is a covered or noncovered health service. Benefits vary by plan; confirm coverage and benefit limitations with the member-specific benefit plan document.

Codes listed are for reference only and are not a guarantee of coverage or payment.
Confirm member benefits and limitations prior to billing.

Documentation Required

Provider Action Highlight

Providers: verify the member-specific benefit plan and any applicable federal or state mandates before rendering services. This policy is informational and does not constitute medical advice.

Check eligibility, benefits, and prior authorization requirements for each member.
Document medical necessity and retain supporting records for claims.

Background

Single‑tooth indirect restorations (inlays, onlays, crowns, laminate veneers) can fail because of restorative material failure or can become separated from their original cement or bond. When failure or separation occurs, procedures such as repair, recementation, or rebonding are considered to restore function and retention; these interventions apply to restorations where the functional area is involved due to restorative material failure or separation from the original cement/bond.

Definitions

Abutment Crowns

DefinitionAn artificial crown that serves as retention or support of a dental prosthesis.

SourceAmerican Dental Association (ADA) definition as used in policy.

Clinical contextUsed as abutments for removable or fixed prostheses where crowns provide support or retention.

Coping

DefinitionA thin covering of the coronal portion of the tooth usually without anatomic conformity; custom made or prefabricated thimble-shaped core or base layer designed to fit over a natural tooth preparation, a post core, or implant abutment to act as a substructure for restorations or prostheses.

UseCan be used as a definitive restoration or as part of a transfer procedure.

Relation to other restorationsServes as substrate onto which other components can be added to give final form to a restoration.

Crown

DefinitionAn artificial replacement that restores missing tooth structure by surrounding the remaining coronal tooth structure or is placed on a dental implant; made of metal, ceramic, polymer materials, or combinations and retained by luting cement or mechanical means.

MaterialsMay be constructed of metal, ceramic, polymer, or combinations thereof.

RetentionRetained by luting cement or mechanical means.

Inlay

DefinitionAn intracoronal dental restoration made outside the oral cavity to conform to the prepared cavity, which restores some of the occlusal surface of a tooth but does not restore any cusp tips; it is retained by luting cement.

ScopeRestores occlusal surface portions but excludes restoration of cusp tips.

RetentionRetained by luting cement.

Laminate Veneer

DefinitionA thin covering of the facial surface of a tooth usually constructed of tooth-colored material used to restore discolored, damaged, misshapen, or misaligned teeth.

IndicationsUsed to restore esthetic concerns such as discoloration, damage, or malalignment of the tooth surface.

MaterialTypically made of tooth-colored restorative materials.