Unraveling The Maryland Bridge Insurance Billing Process

A Maryland bridge is a permanent dental bridge that replaces a missing tooth. It is a cost-effective and non-invasive tooth replacement option, costing between $1,000 to $2,300. Insurance may cover some of the cost of a Maryland bridge. The cost of the procedure varies depending on several factors, including the number of missing teeth, the difficulty of placing the bridge, and any additional treatments required. Maryland bridges are not suitable for everyone and are best for those with good oral hygiene and healthy existing teeth.

Maryland Bridge retainer codes

The Maryland Bridge, also known as a Maryland bonded bridge, is a type of dental bridge that shares a similar structure with the traditional dental bridge. However, unlike traditional bridges, Maryland bridges use a metal or porcelain framework as anchors, eliminating the need for modification of adjacent teeth. This makes Maryland bridges a more affordable option.

When billing insurance for a Maryland Bridge, it is important to use the correct CDT (Current Dental Terminology) codes that correspond to the specific materials used in the procedure. Here are the retainer codes for a Maryland Bridge:

• D6545: This code is for the wing retainer made of cast metal for a resin-bonded fixed prosthesis. It is used to report cast metal wings attached to each side of a permanent tooth to hold the replacement tooth (pontic) in place. Metal retainers are sturdy but not easily adjustable.
• D6548: This code is for the wing retainer made of porcelain or ceramic for a resin-bonded fixed prosthesis. It is used when porcelain or ceramic wings are attached to each side of a permanent tooth, holding the replacement tooth in place.
• D6549: This code is for the wing retainer made of composite or resin. It is used when resin wings are bonded to each side of a permanent tooth to support the replacement tooth.

These codes specifically refer to the "wings" or retainers of the Maryland Bridge, which are attached to the adjacent teeth to hold the pontic (the replacement tooth) in place. The typical fee for each Maryland Bridge retainer is 1/2-3/4 of the pontic fee. It is important to ensure that the codes used for the retainers match the codes used for the pontics in terms of the materials used.

Pontic codes

D6240 is the dental code for a pontic made of porcelain fused to a high noble metal. This type of pontic is constructed with ceramic or porcelain on the outside and a high noble metal, such as gold, platinum, palladium, or silver, on the inside. It can be used for a tooth bridge or an implant bridge.

D6242 is a similar code for a pontic made of porcelain fused to a noble metal, but without the requirement for a high percentage of noble metals.

D6245 is the code for an all-ceramic pontic.

D6251 is the code for a pontic made predominantly of base metal and covered, at least partially, with a tooth-coloured synthetic resin.

Reimbursement issues

When billing insurance for a Maryland Bridge, there are several issues that can impact reimbursement. These include:

• Missing tooth clauses
• Congenitally missing tooth exclusions
• Waiting periods
• Plan and/or "major" maximums
• Minimum age restrictions for prosthetics

It is important to note that dental insurance policies typically cover a portion of the cost for dental bridges, and the amount covered can vary depending on the insurance plan. Maryland bridges usually cost between $1,500 to $2,500 per missing tooth, and insurance may cover 40%-50% of this cost.

To bill for a Maryland Bridge, specific codes are used for the retainers (abutments) and pontics. The retainer codes depend on the material used, such as cast metal (D6545) or porcelain/ceramic (D6548). The pontics are billed separately using the appropriate code from the D6200 series (D6210-D6252).

The typical fee for each Maryland Bridge retainer is 1/2-3/4 of the pontic fee, and the total fee for the bridge would be 2/3 or more of a full 3-unit bridge fee.

Insurance coverage

Maryland bridges are a cost-effective and non-invasive tooth replacement option. However, they are not suitable for everyone and are not as long-lasting as dental implants. The cost of a Maryland bridge varies depending on factors such as the number of missing teeth, the complexity of placement, and any additional treatments required. The typical cost is between $1,000 and $2,300, and insurance may cover some of the expense.

When billing insurance for a Maryland bridge, it is important to use the correct codes to ensure proper reimbursement. The following are the codes used for the retainers (abutments) and pontics:

• D6545: Cast metal retainer for resin-bonded fixed prosthesis.
• D6548: Porcelain/ceramic retainer for resin-bonded fixed prosthesis.
• D6549: Resin retainer for resin-bonded fixed prosthesis.
• D6210-D6252: Fixed Partial Denture Pontics (select the appropriate code from this series).

The fee for each Maryland Bridge retainer (abutment) is typically 1/2 to 3/4 of the pontic fee. The total fee for the bridge would be 2/3 or more of a full 3-unit bridge fee. However, several factors can impact reimbursement for Maryland Bridges, including missing tooth clauses, congenitally missing tooth exclusions, waiting periods, plan maximums, and minimum age restrictions for prosthetics.

It is important to note that insurance coverage for dental procedures, including Maryland bridges, can vary depending on the specific insurance plan and provider. Patients should consult their insurance provider and dentist to understand their coverage and any out-of-pocket expenses they may incur.

Cost factors

The cost of a Maryland bridge will vary depending on several factors. Firstly, the number of missing teeth that need replacing will impact the cost. If you have dental insurance, the cost will also depend on how much your plan covers. The difficulty in placing the Maryland bridge can also affect the price, as well as any additional treatments required for other dental problems.

Maryland bridges are generally a cost-effective option compared to other dental procedures, especially when compared to dental implant procedures. However, it is important to consider the replacement cost, as Maryland bridges do not last as long as dental implants.

The typical fee for each Maryland Bridge retainer (abutment) is 1/2-3/4 of the pontic fee. The total fee for the Maryland Bridge would be 2/3 or more of a full 3-unit bridge fee.

When billing insurance for a Maryland bridge, there are several codes that can be used for the retainers (abutments) and pontics. The specific code depends on the material used, such as cast metal, porcelain/ceramic, or resin.

Some insurance plans may have specific exclusions or restrictions that can impact reimbursement for Maryland Bridges, such as missing tooth clauses, congenitally missing tooth exclusions, waiting periods, plan maximums, and minimum age restrictions for prosthetics.

Frequently asked questions