D2140, D2150, D2160, D2161 Explained for Dentists

Amalgam restorations may not be glamorous, but they still play a role in dentistry—and whether or not you place them regularly, you’re billing amalgam codes more often than you think.

Why? Because many insurance plans downgrade posterior composites to amalgam coverage, and this can lead to confusion, misbilling, and unnecessary write-offs.

Let’s break down the amalgam codes—D2140, D2150, D2160, and D2161—and show you how to code accurately, protect your revenue, and avoid common reimbursement pitfalls.

The Amalgam Codes: Quick Breakdown

CDT CodeDescriptionD2140Amalgam – one surface, primary or permanentD2150Amalgam – two surfaces, primary or permanentD2160Amalgam – three surfaces, primary or permanentD2161Amalgam – four or more surfaces, primary or permanent

These are restorative codes for silver-colored amalgam fillings. Even if you’re placing composite (tooth-colored) fillings, insurance plans may only reimburse up to the allowed amount for amalgam—especially on posterior teeth.

Common Trap: Writing Off the Composite Downgrade

This is one of the most frequent (and costly) mistakes dental teams make.

The Trap:

A patient has a posterior composite filling. The insurance plan only pays up to the amount for an amalgam filling. Your team bills the correct composite code, but when the insurance pays the amalgam rate, your office writes off the difference.

That write-off isn’t required—and in many cases, it’s completely avoidable.

The Right Move:

When insurance issues an alternate benefit (downgrade) to amalgam, you are usually allowed to charge the patient the difference—as long as:

• The patient was informed,

• You billed for the actual procedure performed (composite),

• You are following your contract and local regulations.

Example Script to Use with Patients:
“Your plan only covers silver fillings on back teeth, but we’re doing tooth-colored fillings. Your plan will help with part of the cost, and you’ll be responsible for the difference. We’ll give you a clear estimate before we begin.”

Key Rule: Always bill what you did.

Never bill an amalgam code (like D2150) if you placed a composite just because it matches the allowed amount. That’s misrepresentation—and it’s not worth the risk.

Other Documentation Tips to Prevent Denials

• Clearly chart which surfaces were restored.

• Take intraoral photos or radiographs if possible.

• Document any decay or fracture that justified the restoration.

• Use a restorative charting system that matches tooth numbers and surfaces.

This is especially important when billing D2161 (four or more surfaces)—a higher-fee code that can trigger audits if documentation is weak.

Pro Coding Tip: Know When to Use D2160 vs. D2161

Many offices default to D2160 (three surfaces) even when four or more were restored—simply to avoid insurance pushback.

But if you truly restored four distinct surfaces—code D2161 confidently and back it up with documentation. Don’t under-code just to “play it safe.” You’re shortchanging your practice and undervaluing your work.

Final Thoughts: The True Cost of Write-Offs

Unnecessary write-offs—from coding errors or insurance misunderstandings—can quietly drain thousands from your practice each year. By understanding the purpose and limits of amalgam codes, you can:

• Bill accurately for the care you deliver,

• Charge patients appropriately (when permitted),

• Avoid claim delays and denials, and

• Strengthen your bottom line without compromising compliance.