Picture this: You’ve just finished explaining to your patient that yes, the buildup is necessary—because placing a crown without it is like building a skyscraper on Jell-O. Then the EOB comes back: DENIED. Why? Because the insurance plan “interpreted” the CDT code differently. Sound familiar?

Well, grab your loupes and lean in—because it turns out, there’s a little-known agreement between the American Dental Association (ADA) and dental insurance companies that could be the ace up your sleeve.

Let’s break it down.

The CDT Leasing Agreement — What Most Dentists Don’t Know

Yes, it’s true. Dental insurance companies actually license the CDT codes from the ADA. That means they agree to a very specific set of rules when using the CDT for claims processing. According to the actual contract (yes, it’s real), here’s what they can’t do:

“Licensee shall not direct anyone else to alter, amend, change or modify the CDT editorial content, including the codes, nomenclatures and descriptors…”

In plain English? Insurance plans are not allowed to rewrite CDT definitions to suit their denial habits.

If the CDT descriptor for a buildup says it’s a separately reportable service necessary to retain a crown, then guess what? Your buildup should get paid—as a separate service—unless there’s a valid reason backed by policy, not fiction.

What This Means for You (AKA, the Fun Part)

When an insurance company denies a claim using a made-up reason that contradicts CDT, you now have ammunition. Here’s how to fight back (no flaming torches or ADA protests needed):

1. Request the Policy in Writing
   If a claim is denied due to their “interpretation” of a code, ask for the exact written policy—and how it aligns with the unaltered CDT descriptor. Odds are, it won’t.

2. Politely Reference the Licensing Terms
   Let the rep know that you’re aware the ADA grants them a license that does not permit modifications to CDT codes or descriptors. Ask if they’re sure they’re not violating that agreement. Use your polite but firm voice.

3. Escalate With Confidence
   If you’re stonewalled, escalate. Mention the ADA licensing rules again and, if necessary, contact the ADA's Center for Dental Benefits and Coding at ADA Contact Page. No need to go full-blown tattletale—just let them know you're keeping things honest.

Quick Recap: Turn CDT Into Your Insurance Shield

• CDT codes are leased to insurance plans under strict rules.

• Insurance cannot change, modify, or reinterpret the definitions.

• Buildups, D4346, and other oft-denied codes? You now have leverage.

Use the agreement as a tool, not a threat. You’re not blowing the whistle—just handing it to someone else and suggesting they listen closely.

Final Word: Don’t Fight Blind

For years, dentists have fought insurance denials with nothing but frustration and a pink denial slip. Now you have something better: knowledge and a binding legal agreement that insurance companies signed.

So next time an EOB denies your necessary treatment and tries to rewrite the CDT gospel, channel your inner warrior-dentist. With this agreement in your back pocket, you’re not just quoting codes—you’re defending truth, justice, and molar integrity.

Benjamin Tuinei

Founder - Veritas Dental Resources, LLC
Phone: 888-808-4513

Services:
PPO Fee Negotiators | PPO Fee Negotiating | Insurance Fee Negotiating
Insurance Credentialing | Insurance Verifications

Websites:
www.VeritasDentalResources.com | www.VerusDental.com