Insurance Tips for PRR’s

For many years, dentists lacked a procedure code for placing something more than a sealant but less than the composite filling that extended into the dentin.  That changed in 2011 with the new D1352 code for a Preventive Resin Restoration (PRR).  However, many practices underutilize the new code or use it incorrectly.

The D1352 code is intended for permanent teeth at risk for decay.  The dentist performs a conservative prep of the tooth, usually removing the start of a cavity in the pit or fissure of the tooth.  Then either a resin restoration is placed or a sealant.  If a resin restoration is placed, it does not extend into the dentin—a key distinction between a PRR and a filling.

Since a PRR is preventive, it typically falls under the 100% insurance coverage category, which is good news for everyone.  However, the procedure is new, and many insurance companies assigned a reimbursement similar to a sealant.  The low reimbursement does not take into account the doctor’s time for preparing the tooth.

However, as indicated in this month’s edition of Insurance Solutions Newsletter, we are already seeing a trend where insurance companies are starting to increase their reimbursement for PRR’s.  The next step is for more practices to utilize the code correctly.  Here are a few tips.

PRR’s are preventive in nature, and if a resin filling is placed it does not extend into the dentin.  If a sealant is placed that does not require the dentist to prepare the tooth, this is simply billed as a sealant.  And if a small filling is placed for restorative purposes and/or if it extends into the dentin, this is coded as a one-surface filling.

Be sure everyone in your practice has a clear understanding of the PRR code.  The procedure is a great service for patients.

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