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PR 204 denial code dental

On a dental remittance, code PR 204 means: The service, equipment, or drug is not covered under the patient's current benefit plan. structural: appeal rarely changes it. Plan design is not appealable. Verify the right plan was adjudicated (employer plan changes mid-year cause false 204s), then move to the patient-pay conversation. Prevention is verification: benefit category checks before high-cost treatment plans.

Last verified
2026-08-29
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Source citations

  • X12-CARC X12 Claim Adjustment Reason Codes (official list) (x12.org)

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