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The Regence Group Dental Policy
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Prosthodontics Section - Provisional Retainer Crown

Topic: Provisional Retainer Crown Date of Origin: January 2003
Section: Prosthodontics Policy No: 41A
Last Reviewed: January 2015 Last Revised:
Approved: January 2015  

This Dental Policy has been developed through consideration of generally accepted standards of dental practice, review of dental literature, dental necessity, and as appropriate, government approval.

Benefit determinations should be based in all cases on the applicable contract language. To the extent there are any conflicts between these guidelines and the contract language, the contract language will control.

The purpose of dental policy is to provide a guide to coverage. Dental policy is not intended to dictate to providers how to practice dentistry. Providers are expected to exercise their clinical judgment in providing the most appropriate care.

Provisional Retainer Crown (D6793):

Retainer crown utilized as an interim of at least six months duration during restorative treatment to allow adequate time for healing or completion of other procedures. This is not to be used as a temporary retainer crown for routine prosthetic fixed partial dentures.

Procedure is in accordance with generally accepted standards of dental practice.

Administrative Guidelines
No benefit.

Codes Number Description

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