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N849 Remark Code: Missing Tooth Clause Applied

N849 means the dental plan denied the service under its missing tooth clause: the tooth being replaced was missing before the member's coverage effective date. Plans with this clause generally won't pay to replace teeth lost before coverage started.

Quick facts

Code
N849 (RARC N849)
Status
Active In use since March 1, 2021.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • PR (Patient Responsibility): The service is excluded under the plan's terms, and the patient is generally responsible, subject to any network agreement.
  • CO (Contractual Obligation): If reported as CO, the amount is a provider write-off under the payer's rules or contract.
Official description
Missing Tooth Clause: Tooth missing prior to the member effective date.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N849 means

Many dental plans include a missing tooth clause. It says the plan won’t pay to replace a tooth that was lost before the member’s coverage started, so members can’t enroll specifically to get a bridge, denture, or implant paid for. N849 tells you the plan applied that clause to your claim.

The decision rests on dates: when the tooth was lost compared with the member’s effective date. That makes it one of the few dental denials where documentation of history, not the procedure itself, decides the outcome.

Common causes

  • The tooth was extracted before coverage started, often by another dentist.
  • No extraction date on file, so the plan assumed the tooth was missing before coverage.
  • Intake records show the tooth missing at the patient’s first visit under the plan.
  • New plan after a job change, even when the patient had dental coverage before.

What to do

  1. Confirm the extraction date from your records, prior dentist records, or radiographs.
  2. Review the plan’s terms. Some plans waive the clause with proof of prior continuous coverage.
  3. If the tooth was lost after coverage started, request reconsideration with the extraction records.
  4. If the clause applies, discuss financial responsibility with the patient, subject to any network agreement.

How to prevent it

  • Ask about missing tooth clauses when verifying benefits for prosthodontic or implant work.
  • Get a pre-treatment estimate before starting replacement work.
  • Record extraction dates and tooth numbers carefully so future claims can show them.

Codes that may appear with N849

  • PR-204 (This service/equipment/drug is not covered under the patient's current benefit plan): The service isn't covered under the patient's current benefit plan.
  • CO-96 (Non-covered charge(s).): The charge was treated as non-covered.
  • N384 (Records indicate that the referenced body part/tooth has been removed in a previous procedure.): Records show the body part or tooth was already removed in a previous procedure.
  • N37 (Missing/incomplete/invalid tooth number/letter.): The tooth number or letter is missing or invalid.
  • PR-26 (Expenses incurred prior to coverage.): Expenses incurred before coverage began.

N849 FAQ

What is a missing tooth clause?

It's a dental plan provision that excludes replacing teeth that were already missing when the member's coverage began. It typically applies to bridges, dentures, and implants.

Can the clause be waived?

Some plans drop it after a period of continuous coverage or when the member had prior coverage without a gap. Check the member's plan documents.

What if the tooth was extracted after coverage began?

Then the clause shouldn't apply. Send documentation of the extraction date, such as prior records or claims history, and request reconsideration.