Here in the US there is a billing code for provisional restorations. Do you use it? When? I looked at this question in my practice over a decade ago and developed a protocol. It isn’t foolproof, but allows me to invest the time I need to create and utilize provisionals in many cases where they are a critical component to success – not simply a temporary cover for a prepared tooth.
This is the critical differentiation for me: When the provisional is a restoration in its’ own right. When making it serves a purpose other than covering the tooth that is critical for optimal clinical success we bill the patient for it as a separate service. One distinguishing factor can also be that the provisional will likely be remade or altered prior to fabrication of the final restoration.
In my practice I often use provisional restorations to test esthetic changes. For patients where we are altering tooth position and shape, I use the provisional to allow them to see and accept these changes. We will adjust embrasure form features like incisal edge position and embrasure form and then take impressions of the final provisional for the laboratory to use as a prototype. This same process occurs when I am altering a patient’s occlusal scheme or opening vertical dimension and need to verify the patient’s comfort and function.
Another situation that comes to mind is when a tooth may need crown lengthening. I prefer to make this final recommendation because I have done a preliminary prep and evaluated the ability to place a margin above the attachment, get an adequate impression and remove all decay, cracks etc. I then place a provisional and send the patient to the surgeon. They now have the ability to remove the provisional, gain better access and visualize the challenge they are helping to overcome so they can most effectively perform the surgery.
One of the things I know about charging a fee for these “interim” restorations is it allows me to be comfortable taking my time and doing my best work. The individual circumstances are explained to the patient and why this process will be beneficial, along with the fee.
One of my friends, Dr. Jim Fondriest asked on Facebook “what code do you use….”, so I thought I would share my answer here:
First I’ll say we do not file any of the provisionals to insurance, as they will then exclude payment for the final restoration or place a time restriction. With this in mind a conversation with the patient is important to create understanding as to why the prescribed course of treatment has health value for them. The code we use is D2970, which is a temporary restoration for use when assessing the prognosis of a tooth prior to placing a final restoration.
To see the original discussion, you can visit my Facebook page by clicking on this shortcut:https://www.facebook.com/drleebrady?fref=nf