Diagnosis: Tooth decay. Treatment: D2791--All Metal Crown (Tooth #30, #31); D3330--Nerve Treatment on Molar Tooth (Tooth #30, #31). The insurer denied the D2791--All Metal Crown (Tooth #30, #31); D3330--Nerve Treatment on Molar Tooth (Tooth #30, #31). The denial is overturned. The patient is a female requesting root canal therapy and crowns on teeth #30 and #31. The patient has severe decay into both nerves and will need crowns to restore both teeth. Yes, the proposed metal crowns (D2791) on teeth #30 and #31 and nerve treatment of a molar tooth (D3330) on teeth #30 and #31 are medically necessary. Teeth #30 and #31 are functioning teeth and need the treatments described (root canals and crowns). The denial is based upon the need to keep (i.e., treat) any abutment teeth for bridges or partial dentures, both of which the patient does not have or need. However, the patient has severe tooth decay extending into the nerves of these teeth. These two teeth are fully functional and with the treatments described, will remain fully functional for many years. It is within the standard of care to restore functional teeth. The treatments requested, root canals and crowns, are medically necessary.
1) Contemporary Fixed Prosthodontics by Stephen F. Rosenstiel, BDS, MSD and Martin F. Land, DDS, MSD. Elsevier 2016.