CurrentUnitedHealthcarePolicy DCP024.13

Other Restorative Procedures (Repair/Recement/Rebond/Reattachment/Coping)

Defines indications and coding guidance for repair, recementation/rebonding of single-tooth indirect restorations, reattachment of tooth fragments, and coping related to crown/abutment preparation for UnitedHealthcare dental plans.

Policy Summary

PayerUnitedHealthcare

PolicyOther Restorative Procedures (Repair/Recement/Rebond/Reattachment/Coping)

Policy CodePolicy DCP024.13

Change TypeAdministrative update

Effective DateJul 1, 2025

Next Review Date

Key ActionCheck the member specific benefit plan and applicable mandates for prior authorization and coverage determinations before providing services.

SourceLink

POLICY UPDATE CHANGES

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

10document chunks

12listed CDT procedure codes

2025-07-01effective date

DCP024.13policy identifier

Coverage Criteria

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.

Repair/Recement/Rebond of Single Tooth Indirect Restorations

Covered when ALL of the following are met

Repair/Recement/Rebond: Procedures indicated for an inlay, onlay, crown, or laminate veneer in which the functional area is involved due to restorative material failure.

Reattachment of Tooth Fragment

Covered when ALL of the following are met

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

Not indicated for fractures involving tooth roots.

Coping

Coping inclusion: Coping is considered inclusive to crown preparation/abutment crowns unless a separate procedure is indicated when insufficient tooth structure remains to retain the crown or to allow a common path of insertion when retainer teeth are tipped or misaligned.

Reattachment of a tooth fragment is appropriate only when the fracture is confined to the crown (enamel and dentin) and there is a recoverable fragment to bond. Reattachment is not indicated for fractures involving tooth roots. Treatment decisions should document the location and extent of the fracture and that root involvement is absent before proceeding with reattachment.

Coding / Procedure Codes

Applicable CDT Procedure CodesCDT

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.

1–10 of 11

1/2

Provider Actions & Billing Notes

Prior Authorization

Prior Authorization and Coverage Notes

Prior authorization requirements are determined by the member specific benefit plan. Inclusion of procedure or diagnosis codes in this guideline is for reference only and does not guarantee coverage or payment. Always verify prior authorization requirements with the member's plan before providing services.

Prior authorization depends on member plan — Confirm with the member specific benefit plan prior to performing services
Coverage determined by member benefit plan — Inclusion of a code does not imply the service is covered; benefit coverage is determined by the member specific benefit plan
Reference member specific benefit plan — When deciding coverage, the member specific benefit plan document must be referenced; in the event of conflict, the member specific plan governs

Documentation Required

Provider Action Required

Providers should review the member specific benefit plan for coverage, prior authorization, and documentation requirements. Ensure billing uses the most specific CDT code available and include supporting documentation when submitting claims to reduce risk of denial.

Provider action: Verify member eligibility and prior authorization requirements before scheduling procedures
Provider action: Use specific CDT codes (see Applicable Codes) and attach documentation showing medical necessity when required
Provider action: In case of discrepancy between this policy and the member specific benefit plan, follow the member specific benefit plan

Note

Coverage Determination Reminder

Listing of a code in this guideline does not imply that the service described by the code is a covered or noncovered health service. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws. The inclusion of a code does not imply any right to reimbursement or guarantee claim payment.

Affected codes are provided for reference and may not be all inclusive
Other Policies and Guidelines may apply — check plan documents and applicable mandates

Background

Single-tooth indirect restorations—including inlays, onlays, crowns, and laminate veneers—are used to restore tooth form and function. These restorations can fail either because of restorative material failure (fracture, chipping, wear) or loss of adhesion to the tooth, which may make repair, recementation, or rebonding appropriate. When a tooth fracture is limited to enamel and dentin, reattachment of the original tooth fragment may be an option; root-involving fractures are not amenable to fragment reattachment.

Definitions

Abutment Crowns

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

ContextReferenced as part of crown and bridge preparations where abutment crowns provide retention for prostheses.

SourceADA definition as provided in policy document.

Coping

DefinitionA thin covering of the coronal portion of the tooth, custom made or prefabricated, acting as a substructure for a restoration or prosthesis; can be used as a definitive restoration or part of a transfer procedure.

Clinical noteDesigned to fit over a natural tooth preparation, post core, or implant abutment to allow addition of other components to give final form to a restoration.

RetentionMay be used as a definitive restoration or as part of the crown/abutment workflow when separate procedure is indicated.

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.

MaterialsConstructed from metal, ceramic, polymer materials, or combinations thereof.

Retention methodRetained by luting cement or mechanical means.

Inlay

DefinitionAn intracoronal dental restoration made outside the oral cavity to conform to the prepared cavity, restoring some of the occlusal surface but not cusp tips; retained by luting cement.

ScopeRestores occlusal surfaces within the intracoronal space but does not restore cusp tips.

FabricationFabricated outside the oral cavity and cemented into the prepared cavity.

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.

IndicationUsed to improve esthetics or correct surface defects on the facial surface of anterior teeth.

MaterialTypically tooth-colored materials as noted in ADA definition.

Repair/Reattachment indications

When appropriateRepair, recementation, or rebonding is indicated when failure is limited to restorative material or adhesion for an inlay, onlay, crown, or laminate veneer involving the functional area due to restorative material failure.

Reattachment of tooth fragmentIndicated for tooth fractures confined to enamel and dentin with loss of structure; not indicated for fractures involving tooth roots.

LimitationsProcedures are appropriate only when failure is limited to restorative material or fracture does not involve root structure.

Related proceduresIncludes re-cement/re-bond of inlays, onlays, crowns, veneers and repairs for restorative material failure as defined by CDT codes in the policy.