Ann answers your questions - Insurance companies only will pay for one filling on the same tooth on the same day?

Hi Ann,

This is an insurance question that's been bothering me for years. I've been in practice for 36 years. A lot of patients come in having two cavities on one tooth. For example, an mlfi and a dlfi. These are different surfaces on the same tooth. Insurance companies only will pay us for doing only one filling on the same tooth on the same day. What is the right thing to do in order to get paid for both fillings. 

What would you do as a dentist ? 

Thank you in advance,

Dr. Shutty.

Hello Dr. Shutty,

Thank you for your question which points out a most bothersome problem. I understand your frustration when two separate restorations are necessary on the same tooth, but insurance companies will compensate for only one. This has been a problem for dentists as far back as most can remember.

There is no perfect answer to the problem which seems to be universal with insurance companies and many state Medicaid plans as well. If a dentist were to do one four surface restoration at one appointment and schedule the second at another appointment, the patient is inconvenienced with two appointments plus, most likely, two injections of anesthesia. That is not an acceptable answer.

My suggestion is that you contact the American Dental Association to ask if the ADA has made any inroads in addressing this quandary. The ADA has the collective clout of all of you practicing dentists and may well be the only organization powerful enough to demand an answer to the problem. Perhaps a change in CDT coding could rectify the problem. I urge you to contact the ADA soon, before the Code Maintenance Committee (CMC) meets to update CDT codes for 2017. The CMC will take suggestions for 2017 code changes until November 1, 2015. You can find information about code changes, deletions, or additions at ADA.org/publications/cdt.

Since all of your colleagues face the identical problem, you may want to survey some of them to seek additional thoughts on this topic. And some of your peers may want to contact the CMC before the November 1 deadline also.

Ann.