D6245Pontic - Porcelain/Ceramic

What This Code Covers

D6245 covers a pontic (the false tooth in a bridge) made entirely of porcelain or ceramic material. The pontic replaces the missing tooth and is fused between the bridge retainers (crowns on the abutment teeth). An all-ceramic pontic provides excellent esthetics and is commonly used in the visible front teeth area where a natural appearance is most important.

Billing Guide

Bill this code when:

• An all-porcelain or all-ceramic pontic is part of a fixed bridge
• The pontic is the replacement tooth section of the bridge
• The bridge also includes retainer crowns (D6740, D6750, D6752, etc.) on the abutment teeth
• The pontic material is entirely ceramic with no metal substructure

Do not bill this code when:

• The pontic is porcelain fused to metal. Use D6240 (high noble) or D6242 (noble) or D6241 (base)
• The pontic is a single crown (pontics are only part of bridges, not standalone)
• An implant crown is being placed instead of a bridge. Use D6058 or D6065
• The bridge retainer codes are being billed (those are separate)

Insurance and Denial Prevention

Key Payer Rules:

• D6245 is billed per pontic (per missing tooth replaced)
• The pontic code is billed alongside retainer codes for the abutment teeth
• Some payers apply LEAT and pay all pontics at the PFM rate regardless of material
• Bridge benefits are typically under the major restorative category at 50% coverage
• Most plans require the tooth to have been extracted (not congenitally missing) for coverage

Common Denials and How to Respond:

• Downgraded to PFM rate - The payer is applying LEAT. The patient may owe the difference. Document the esthetic need if the pontic is in the smile zone.
• Implant recommended instead - If the payer suggests an implant, document why a bridge was the appropriate treatment choice for this patient.
• Missing tooth documentation - Submit documentation showing when and why the tooth was lost (extraction record, radiograph showing missing tooth).