Most common D5797 code reviews : Implant/abutment supported interim fixed denture for edentulous arch - maxillary - not covered, Mesial/distal wedge procedure, single tooth (when not performed in conjunction with surgical procedures n the same sanatomical area) or Resin-based composite - four or more surfaces or involving the incisal angle (anterior).
Sealant-per tooth Sealants and/or Preventive Resin Restorations are Benefited once per tooth on the occlusal surface of permanent first and second molars for Patients through age fifteen (15). The teeth must be free from caries orrestorations on the occlusal surface. A sealant or preventive resin restoration done on the same date of service and on the same surface as a restoration is considered a component of the restoration, and the fee for the sealant or preventive resin restoration is Disallowed.
Procedure in D5797 which the nearly exposed pulp is covered with a protective dressing to protect the pulp from dditional injury and to promote healing and repair via formation of secondary dentin This code is not to be used for bases and iners when all caries has been removed.
Dental case management - patient education to improve oral health literacy. (Not covered service as opposed to when performed as follows: Disallowed when performed on same date of service as nutrition, tobacco counseling and/or oral hygiene instructions.)
Prefabricated post and core in addition to crown is payable only on a completed endodontically treated tooth. If sufficient tooth structure remains, the fee for the post and core is Disallowed. **A prefabricated post and core for an anterior tooth is Benefited only when there is insufficient tooth structure to support an indirectly fabricated restoration. If sufficient tooth structure remains, the fee for the post and core is Disallowed.
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