Army Dentistry

Finally, there is a code for a PRR! I do a lot of these so called “preventive resins” in the Army. For those who dont know what it is it is something between a sealant and a filling. So many young soldiers come to see me with early carious lesions on occlusal surfaces that I find myself in the dilemma of choosing to code the procedure as D1351 (sealant) or D2391 (one surface posterior composite) all the time. Most of the time my rationale was this: if decay was present, even if it was limited to enamel, then it was not a preventive therapy and I coded it as a one surface occlusal. If I was doing this to prevent caries from forming in “deep pits and fissures” then I coded it as a sealant. The procedures are virtually the same in my practice: rubber dam, fissurotomy, etch, bond, some type of flowable resin, finish, polish, check the occlusion. Sometimes I throw in GLUMA or chlorhexidine prior to etching depending on the situation.

I hated finding myself in those predicaments. And with 18-24 year olds with moderate to high caries risk, I found myself in that situation quite often. In private practice (or dental school) there are some ethical dilemmas that pop up here. First, the previous definitions required that for it to be coded as a filling it had to go all the way into dentin. If you’re in private practice that gives you incentive to go “just a little further” into the dentin to guarantee your reimbursement from insurance. Same thing in dental school when you’re desperately trying to get credit for composite procedures in a school that may be very pro amalgam just so you can graduate.

I have only one issue which is Dr Blairs statement: “The code will probably be reimbursable for PRR on children and patients up to 16 years old, especially on newly erupted molars.” I would say to him and those at the ADA that limiting reimbursement to those under 16 is a mistake. Adults are susceptible to caries as well and should be given the best and most conservative treatment available for those in their situation – be it a sealant, a PRR, or a 1 surface occlusal composite. Insurance should neither discriminate on age nor dictate care.

So I applaud the ADA for realizing the problem with this and coming up with a solution. To all the naysayers concerned about potential fraud, I say relax and realize this is a step in the right direction.