Dental fillings for caries - what options are there and how are they billed?

What are dental fillings for?

Fillings are necessary to restore stability and function to damaged tooth structures. Tooth decay is a common cause of tooth loss and pain. By using fillings, the dentist can clean and disinfect the affected areas and fill them with suitable material.

In the dental practice, various materials are used to fill cavities, i.e. cavities caused by caries, and to restore the tooth structure. The choice of the right filling material depends on various factors, including the extent of the decay, the topography of the affected tooth, aesthetic considerations and the patient's financial means.

What filling options are there?

Here are some of the most common filling materials used in dentistry:

1. Amalgam: Amalgam fillings consist of an alloy of mercury, silver, tin and copper. They have been used in dentistry for over a century and are known for their durability and resistance to chewing pressure. However, they are silver in color and therefore less aesthetic than the other materials. Due to concerns about mercury content, amalgam fillings are being used less and less in some countries.
2. Composite: Composite fillings are made of a plastic resin that is available in the color of the natural tooth. They are aesthetically pleasing as they blend in well with the natural tooth color. Composite fillings are placed directly into the cavity and are used in the front teeth and other visible areas. However, they are less durable than amalgam fillings and can discolor or wear away over time. Single-colored composite fillings are covered by health insurance for visible teeth. If the patient wants a composite filling in the posterior region, the treatment costs are not fully covered by statutory health insurance.
3. Ceramics (inlays and onlays): Ceramic fillings are made of porcelain-like material and are aesthetically pleasing. They are very durable and resistant to discoloration. Inlays and onlays are special types of ceramic fillings that are made in the dental laboratory and then inserted into the tooth with a luting cement. They are often used for larger cavities or to restore the tooth structure.
4. Gold alloys: Inlay fillings with a gold alloy are extremely durable and corrosion-resistant. They are made in dental laboratories and inserted into the tooth. Although they are very effective, they are usually limited to use in non-visible areas of the mouth due to their conspicuous appearance.
5. Cement and glass ionomer cement: These materials are particularly suitable for fillings in children or in areas with low chewing and pressure stress. They are less robust than other filling materials, but are biocompatible. Simple dental cement, such as phosphate cement, is often used for temporary (provisional) filling of cavities, especially if the tooth is to be treated later with a permanent filling. It is an inexpensive material, but it is not as durable as other options.

Deciding on the right filling material

But how do you decide which filling material to use? Choosing the right filling material depends on many factors, including the patient's individual needs and preferences, the size of the cavity and the dentist's recommendations/education. The practitioner will recommend the best option for the individual case and educate and advise the patient on the various options.

How are dental fillings calculated?

The billing of dental fillings for patients with statutory health insurance is generally based on the German standardized assessment scale (BEMA). If filling materials are used that do not comply with the health insurance guidelines, billing is based on the schedule of fees for dentists (GOZ).

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Billingof dental fillings for patients with statutory health insurance

Patients with statutory health insurance are entitled to free treatment in filling therapy. Adhesively bonded fillings in the anterior region are generally covered by the health insurance. The calculation is BEMA number 13a-d.

If multi-colour techniques are used for the purpose of aesthetic optimization, these fillings are not part of the contractual dental care, even for anterior teeth, and can be charged as fillings eligible for additional costs according to the GOZ. The GOZ positions are 2060, 2080, 2100 and 2120. Inlays (inlay fillings) are charged according to GOZ positions 2150, 2160 and 2170. The statutory portion of the filling (BEMA 13a-d) is deducted from the GOZ calculation so that the patient pays the additional costs of the filling.

When and how can additional costs be charged?

These additional costs may only be charged if there is an indication for SHI treatment in the specific case. This means that the tooth to be treated is decayed or already has insufficient fillings. If there is no indication for SHI treatment, the entire treatment will be billed privately. In addition, an "agreement on private treatment" in accordance with Section 8 (7) BMV-Z is made prior to treatment.

The provision for calculating additional costs in the context of filling therapy is Section 28 (2) sentence 2 SGB V:

If insured persons opt for a more extensive treatment for fillings, they must bear the additional costs themselves. In these cases, the health insurance funds must invoice the comparably priced plastic filling as a benefit in kind. In cases covered by sentence 2, a written agreement must be reached between the dentist and the insured person before treatment begins. The additional cost regulation does not apply to cases in which intact plastic fillings are replaced.

It is important to reach a written additional cost agreement with the patient.

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‍Wichtig ist, mit dem Patienten eine schriftliche Mehrkostenvereinbarung zu treffen.

What are the exceptions to the billing of dental fillings?

If composite fillings are used in the posterior region in accordance with BEMA numbers 13e, f and g, these can only be billed if they are performed using an adhesive technique and if an amalgam filling is contraindicated, i.e. if the patient has a proven allergy to the filling material or its components in accordance with the criteria of the contact allergy group of the German Society for Dermatology. Amalgam is also contraindicated in the presence of severe renal insufficiency. Furthermore, amalgam should not be used in pregnant or breastfeeding patients or in children up to the age of 15.

The right communication with patients is crucial

In principle, it is important that patients receive a clear cost breakdown from their dentist before treatment. Private supplementary dental insurance can cover some of the costs, but this depends on the individual insurance conditions.

If you are a dental assistant and would like to learn more about how best to communicate with patients, then Ms. Monka-Lammering and Nelly's webinar is for you. In it, we will talk about the use of digital tools and explain how you can save more time in your day-to-day practice thanks to automated processes in patient communication. The whole thing will take place on November 23 at 7 pm and is free of charge.