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

‍What are dental fillings for?

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

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

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-coloured 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 consist of a plastic resin that is available in the color of the natural tooth. They are aesthetically appealing as they blend well with the natural color of the teeth. Composite fillings are placed directly into the cavity and used in the anterior tooth area and other visible areas. However, they are less durable than amalgam fillings and may discolor or wear out over time. The monochrome composite fillings are a cash payment in the visible area of the teeth. If the patient wants a composite filling in the posterior area, the treatment costs will not be fully covered by the statutory health insurance.
3. Ceramics (inlays and onlays): Ceramic fillings are made from porcelain-like material and are aesthetically appealing. They are very durable and resistant to discolouration. Inlays (inlays) and onlays are special types of ceramic fillings that are produced in a dental laboratory and then inserted into the tooth with a fixing cement. They are often used for larger cavities or to restore the tooth structure.
4. gold alloys: Gold alloy infills are extremely durable and resistant to corrosion. They are produced in dental laboratories and inserted into the tooth. Although they are highly effective, their eye-catching appearance means they are usually limited to use in invisible areas of the mouth.
5. cement and glass ionomer cement: These materials are particularly suitable for fillings for children or in areas with low chewing and pressure stress. Compared to other filling materials, they are less robust but biocompatible. Simple dental cement, such as phosphate cement, is often used to temporarily (provisionally) fill 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 individual needs and preferences of the patient, the size of the cavity, and recommendations or information provided by the dentist. The practitioner will recommend the best option for the individual case and will inform and advise patients about the various options.

How are dental fillings calculated?

Dental fillings for legally insured patients are usually billed in accordance with uniform federal evaluation standard (BEMA). When using filling materials that do not comply with cash register guidelines, according to Schedule of fees for dentists (GOZ) settled.

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AbrechnTreatment of dental fillings for patients with statutory insurance

Patients with statutory insurance are entitled to free filling therapy treatment. In the anterior tooth area, adhesively attached fillings are usually the cash payment. The calculation is BEMA number 13a-d.

If multicolor techniques are used for aesthetic optimization, these fillings are not part of contract dental care even for front teeth and can be calculated as additional costs in accordance with the GOZ. The GOZ positions are 2060, 2080, 2100 and 2120. Inlays (infills) are calculated according to GOZ positions 2150, 2160 and 2170. The legal 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 calculated?

These additional costs may only be calculated if there is an indication for GKV treatment in a specific case. This means that the tooth to be treated is carious or that there are already inadequate fillings. If there is no indication for GKV treatment, the complete treatment will be billed privately. In addition, a “private treatment agreement” 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 choose additional treatment for dental fillings, they have to bear the additional costs themselves. In these cases, the cash registers must charge the comparably cheapest plastic filling as a benefit in kind. In cases covered by sentence 2, a written agreement must be made between the dentist and the insured person before the start of treatment. The additional cost regulation does not apply to cases in which intact plastic fillings are replaced.

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

What exceptions are there when billing dental fillings?

When using composite fillings in the posterior area in accordance with BEMA numbers 13e, f and g, these can only be billed if they are provided using adhesive technology and if amalgam filling is contraindicated, i.e. if the patient has a proven allergy to the filler or its components in accordance with the criteria of the contact allergy group of the German Society of Dermatology. Amalgam is also contraindicated in the presence of severe renal failure. Furthermore, amalgam should not be used in pregnant and breast-feeding patients or in children up to 15 years of age.