Amalgam buildup dental code

[Afualo12]

I’m in the Military and do a ton of amalgam buildups that also serve as a permanent crowns. Just curious what code to use if I were in private practice. These procedures can be time consuming and skillful if the dentist wants to replicate natural tooth anatomy and proper occlusion. Often they can also extend sub-gingival.


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[oralcare123]

I don't see a point in doing those in private practice

 

[OhioDMD]

It’s either a D2161 amalgam 4 surface plus D2951 if pins were used. This assumes this is the final restoration (at least for now) and is generally covered at the basic rate. If you are doing an amalgam pin core buildup prior to a crown then the code should be D2950 core buildup including pins. This code is usually covered at the same percentage as crowns.

 

[ysrebob]

OhioDMD is right about the ADA codes to use... and oralcare123 is also right. Given the time it takes to do a good full cuspal MODFL amalgam vs the usual and customary fee you’re reimbursed for these codes, it’s hard to even cover your costs doing this in private practice. I do cuspal amalgams for patients who can’t afford a crown and would otherwise lose the tooth, but in the spirit of community service. Ie I take a loss on them. (Former USAF dentist.) The problem is the cost of your chair time. Overhead in a typical office runs several hundred dollars an hour.

 

[lemoncurry]

I work in an FQHC/public health/community clinic and I don't even bother with amalgam. It just takes too long to place and I hate using it, hate working with it. I'm not against it as a material, but given the choice between doing an amalgam crown or a bulk fill composite, you bet I'm going composite all the way. It may cost more for the materials, but the chair time is waaaaay shorter.

 

[ysrebob]

I'm going to give away my military dentist roots here and say amalgam is IMO a highly underrated and underused material. Much higher compression strength than composite, and less prone to recurrent caries. A well-done full cuspal amalgam like Afuolo12 is talking about will likely last forever, unlike any large composite. At least in the Air Force, this is often the final/definitive restoration after molar RCT, so any mil dentist gets competent with doing them. If you get a knack for it, you can make truly beautiful (to a dentist) cuspal amalgams, as anatomically realistic and occlusally detailed as a gold crown. But it takes probably 90+min of chair time to do it. That's the killer. For small restorations like MO or DO slots, doing amalgam is actually faster than incrementally placed composite, with a little practice. I wish I could use it more in private practice (tough sell, tho -- seen as old-fashioned).

 

[lemoncurry]

I'm going to give away my military dentist roots here and say amalgam is IMO a highly underrated and underused material. Much higher compression strength than composite, and less prone to recurrent caries. A well-done full cuspal amalgam like Afuolo12 is talking about will likely last forever, unlike any large composite. At least in the Air Force, this is often the final/definitive restoration after molar RCT, so any mil dentist gets competent with doing them. If you get a knack for it, you can make truly beautiful (to a dentist) cuspal amalgams, as anatomically realistic and occlusally detailed as a gold crown. But it takes probably 90+min of chair time to do it. That's the killer. For small restorations like MO or DO slots, doing amalgam is actually faster than incrementally placed composite, with a little practice. I wish I could use it more in private practice (tough sell, tho -- seen as old-fashioned).

You're 100% right about all that. Part of me wishes I were more comfortable in placing them, especially larger ones, but at this stage of the game, I feel like I would have to add another 30 minutes to my appointment times (i schedule in 30 min increments) if I were to start using it.

Incremental composite is something I never use for posteriors. Bulk fill or bust.