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An inlay is an indirect restoration constructed of cast metal, porcelain/ceramic, or composite/resin that neither supports nor replaces a cusp (or cusps) of a tooth. The inlay restoration is nothing more than a centric stop in that it provides no protection for the cusp tip as concerns lateral and/or protrusive masticatory forces in excursions.
The onlay component of an inlay/onlay restoration is another story. The onlay component replaces the cusp tip (or tips). The onlay entirely replaces the cusp tip so as to maintain and/or restore the vertical dimension in the preparation. When the cusp tips are sound (Figures 3, 6, and 8), the original vertical dimension is not altered.
The coding sequence provides for a single code number to identify an inlay with an associated onlay component. As we all know, it is a technical impossibility to construct an onlay without first identifying the surfaces of the inlay. Hence, the descriptions are currently somewhat misleading.
With regard to third-party reimbursement, few if any benefit plans consider an inlay in the absence of an onlay component to be a contractual benefit. Since an inlay is nothing more than a centric stop that adds little or no strength to the remaining natural tooth structure, it is traditionally reimbursed at the level of a traditional, direct restoration.
Inlay restorations (Figures 6, 7, and 9) are optional benefits when the tooth can be restored adequately with a similar direct restoration. An allowance is generally made for that similar material, and the patient is responsible for the difference in cost.
| Table. 2010 Resin-Based Composite Inlays/Onlays |
| Code |
Description |
Lower |
Low |
Medium |
High |
Higher |
Average |
RV |
| |
Inlay/Onlay Restorations |
|
|
|
|
|
|
|
| D2650 |
Inlay-resin based composite
composite/resin-1 surface |
$205 |
$448 |
$450 |
$801 |
$1,115 |
$574.00 |
13.05 |
| D2651 |
Inlay-resin based composite
composite/resin-2 surfacea |
$250 |
$493 |
$495 |
$846 |
$1,200 |
$619.00 |
14.07 |
| D2652 |
Inlay-resin based composite
composite/resin-3 or more surfaces |
$350 |
$593 |
$595 |
$946 |
$1,300 |
$719.00 |
16.34 |
| D2653 |
Onlay-resin based composite
composite/resin-3 surfacea |
$500 |
$743 |
$745 |
$1,096 |
$1,450 |
$869.00 |
19.75 |
| D2654 |
Onlay-resin based composite
-4 ore more surfaces |
$554 |
$783 |
$795 |
$1,169 |
$1,475 |
$968.70 |
22.02 |
This data represents 100% of the 90th percentile. The relative value is based upon the national average and not the individual columns of broad-based data. The abbreviated code numbers and descriptors are not intended to be a comprehensive listing.
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drsushant