Dentovio public answer
crown narrative for dental insurance
Sourced answer
A crown narrative should identify the tooth and the billed code, state the charted findings that made a full-coverage restoration necessary, state the pre-operative image on file and its date, and list what is attached. The published payer rules converge on a current dated pre-operative radiograph: Delta Dental Ins. criteria specify a periapical, not a panoramic, taken within one year of the preparation; Guardian asks for a diagnostic-quality pre-operative radiograph taken within 24 months; Aetna takes radiographs that are duplicates, unannotated and less than 36 months old, and qualifies a full crown on 50% or more structural loss, an existing restoration covering half the tooth, or an endodontically treated tooth; Cigna's REST-03 pays when the submitted information confirms extensive decay or fracture that cannot be restored with an amalgam or composite resin filling; and DentaQuest's Colorado manual sets numeric surface and cusp counts by tooth type. Aetna also excludes crowns placed strictly for cosmetic reasons and a tooth whose clinical crown is carious at or below the osseous crest.
- Cluster
- Practice operations
- Last verified
- 2026-08-30
- Reviewer
- None — owner-published
Dentovio is an independent publisher — not a dental payer, the ADA, X12, or any government agency. This page was drafted with AI assistance and verified against the primary sources linked here. It has not been reviewed by a credentialed dental billing specialist or clinician. The templates and the builder assemble sentences from entries you make; they do not generate clinical content, and they state only what you record. The payer criteria shown are those payers' published documentation rules as read on the last-verified date; individual plan contracts still control coverage, frequencies, and exclusions, and payers revise policy documents on their own schedules. Educational billing reference only, not billing, legal, or clinical advice. CDT codes are referenced by number only; CDT codes and descriptors are the property of the American Dental Association. This page provides educational billing guidance only and does not reproduce ADA copyrighted descriptors.
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Source citations
- NARRATIVE-D2740-CROWNS-1-1 Aetna Dental Clinical Policy Bulletins index (44 bulletins) (aetna.com)
- NARRATIVE-D2740-CROWNS-1-2 Aetna Dental and Oral Surgery Claim Documentation Guidelines, last updated July 21, 2025 (PDF) (aetna.com)
- NARRATIVE-D2740-CROWNS-2-1 Cigna Dental Clinical Coverage Determination Guidelines — DPPO, 2026 edition, doc 928339 (PDF) (static.cigna.com)
- NARRATIVE-D2740-CROWNS-2-2 Cigna Dental Clinical Coverage Determination Guidelines — DPPO, May 2026 re-issue, form 999493 05/26 (PDF) (campaigns.cigna.com)
- NARRATIVE-D2740-CROWNS-3-1 Delta Dental Ins. Clinical Criteria / Utilization Management, Section 4, effective January 1, 2025 pending state regulatory approval (PDF) (www1.deltadentalins.com)
- NARRATIVE-D2740-CROWNS-3-2 Delta Dental FYI — claim tips for core buildups and crown lengthening, December 2, 2022 (www1.deltadentalins.com)
- NARRATIVE-D2740-CROWNS-4-1 Guardian provider toolkit — public clinical-guidelines link (guardianlife.com)
- NARRATIVE-D2740-CROWNS-4-2 Guardian Dental Clinical Guidelines 2026, updated August 12, 2026 (PDF) (storage.pardot.com)
- NARRATIVE-D2740-CROWNS-5-1 DentaQuest Colorado Health First Office Reference Manual (PDF) (dentaquest.com)
- NARRATIVE-D2740-CROWNS-5-2 DentaQuest Indiana ORM via Humana (PDF) (dentaquest.com)