D6240 Dental Code: PFM Bridge Pontic Billing Guide

What D6240 covers

D6240 reports a porcelain-fused-to-metal pontic in a fixed bridge: the replacement tooth suspended between two abutments, with porcelain bonded to a high noble metal substructure (gold-platinum or a similar high-content noble alloy). The code includes lab fabrication, connection to the retainer crowns, try-in and adjustment, and cementation as part of the bridge. Bill one D6240 per pontic after the bridge is cemented.

It does not cover:

• Pontics on a predominantly base metal substructure. Use D6241.
• Pontics on a noble metal substructure. Use D6242.
• Full-cast metal pontics with no porcelain. Use D6210 (high noble), D6211 (predominantly base), or D6212 (noble).
• All-ceramic pontics. Use D6245.
• Resin or acrylic-faced metal pontics. Use the appropriate D6250 series code.
• The retainer crowns on the abutment teeth. Use D6750 (high noble), D6751 (predominantly base), or D6752 (noble) for PFM retainers.
• The retainers of an implant-supported bridge. Those come from the implant retainer family that starts at D6068. D6065 is a single implant crown, not a bridge unit. A high noble PFM pontic in an implant bridge is still D6240.
• The bonded wings of a resin-bonded (Maryland) bridge. Those are D6545, D6548, or D6549. A high noble PFM pontic in a resin-bonded bridge is still D6240.
• Single crowns on natural teeth or implants. Bridge codes apply only when the units are connected as a fixed prosthesis.

The bridge dental codes guide lays out every pontic and its matching retainer crown by material.

What separates D6240 from D6241 and D6242

The metal substructure decides the code:

• D6240: porcelain fused to high noble metal. At least 60% noble metal content, with at least 40% gold, typically a gold-platinum or gold-palladium alloy. Higher cost, better marginal accuracy, and lower allergy potential than base metal alloys.
• D6241: porcelain fused to predominantly base metal. Less than 25% noble metal content, typically nickel-chromium or cobalt-chromium. Lower cost. Some patients have nickel sensitivity, which can be a clinical consideration.
• D6242: porcelain fused to noble metal. At least 25% but less than 60% noble metal content, between the other two.

The lab work order should specify the alloy, and the chart should match it. Carriers occasionally audit metal-bridge claims, and the designation has to be defensible.

The missing-tooth clause as the dominant billing pattern

The missing-tooth clause is the most consequential coverage rule on bridges. It excludes prosthetic replacement of teeth that were missing before the patient’s current coverage started. The pontic replaces the missing tooth, so the exclusion always reaches it. What happens to the retainer crowns depends on the plan’s wording.

On a typical case:

1. The patient lost tooth #19 five years before the current coverage started.
2. The dentist plans a three-unit bridge: D6750 on #18, D6240 pontic for #19, D6750 on #20.
3. The carrier excludes the pontic for #19. The retainers on #18 and #20 go one of two ways. A plan worded around the initial placement of a bridge, like Cigna’s Colorado individual policy, excludes the whole bridge. A plan that reviews abutment teeth on their own merits, as PEHP’s 2026 guide describes its rule, may pay a retainer where the tooth needed a crown anyway.
4. Whatever the plan excludes is usually the patient’s responsibility, subject to the network agreement and the financial agreement the patient signed.

Wording also varies beyond those two patterns. Some plans exclude the pontic entirely, some prorate by the number of pontic teeth lost before coverage, and a few do not apply the exclusion at all. The benefit booklet is the source of truth. The wording patterns carriers use are in our guide to the missing tooth clause.

Top reasons D6240 gets denied or downgraded

1. Missing-tooth clause exclusion. The most common case. The pontic is excluded, and on plans worded around the initial placement of a bridge, the retainers are excluded with it.
2. Frequency limit hit. A prior bridge or partial denture covered the same tooth position within the plan’s frequency window. Appeal with documentation of the prior prosthesis failure.
3. Bridge span considered excessive. Some plans pay a removable partial allowance on long spans; Hawaii Dental Service’s 2023 guidelines do this above four anterior or three posterior pontics. A narrative explaining the clinical case helps on review.
4. Wrong metal designation. D6240 was billed but the lab used predominantly base metal, which is D6241. A carrier audit may reconcile against the lab invoice.
5. No documentation of the missing tooth. Some carriers require a panoramic radiograph or chart documentation showing the missing tooth position and the proposed bridge. A pre-op pano usually clears the request.

The bridge claim as a unit: pontic plus retainer crowns

D6240 never bills alone. A bridge claim lists one pontic code per pontic and one retainer crown code per abutment, all on the cementation date:

• Three-unit bridge: D6750 on the mesial abutment, D6240 for the pontic, D6750 on the distal abutment. Three lines.
• Four-unit bridge with two pontics: D6750, D6240, D6240, D6750. Four lines.

D6240 pairs with D6750, both high noble PFM, and the lab work order should specify the same alloy for both. The carrier processes each code separately for coverage and patient responsibility, but the chart should document the bridge as one prosthesis: the design, the lab work order, and the cementation.

Documentation that supports the claim

The claim needs:

• The date of service (the cementation date).
• Tooth numbers for each pontic and each abutment.
• The metal designation, matching the actual alloy.
• A panoramic radiograph or pre-op periapical for some carriers.

The patient record should include:

• The bridge design: number of units, pontic positions, abutment teeth.
• The lab work order, including the alloy.
• Try-in date and fit verification.
• Cementation material and date.
• Occlusion checked and adjusted.
• The date the missing tooth was lost, from the patient’s records, prior carrier records, or the patient interview. This date drives the missing-tooth clause.
• For a bridge replacement, the date and clinical reason the prior bridge was replaced.

Example case

A 51-year-old patient is missing tooth #19, lost three years ago to a fracture, before the current policy started. Teeth #18 and #20 are sound and well restored. The patient wants a fixed bridge instead of an implant. The plan’s missing-tooth clause excludes replacement of teeth lost before current coverage.

Treatment:

1. Visit 1: diagnostic impressions, periodontal evaluation, treatment plan.
2. Visit 2: abutment preparations on #18 and #20, impressions, temporary bridge.
3. Visit 3, two weeks later: try-in, occlusion check, cementation.

Billing:

1. Verify the bridge coverage rules and the missing-tooth clause wording.
2. Run a pre-treatment estimate and quote the patient from the carrier’s response, which shows whether the clause excludes only the pontic or the whole bridge.
3. On the cementation date, submit D6750 on #18, D6240 on #19, and D6750 on #20.
4. Specify high noble metal on the claim and in the chart.

If the plan does not apply the missing-tooth clause to this case, the EOB pays at the full bridge allowable. The pre-treatment estimate sets the expectation either way.