What documentation do dental payers require for crowns (D2710–D2799) claims?

For crown claims (D2710–D2799), the published payer rules converge on one core requirement: a current, dated pre-operative radiograph — Delta Dental Ins. criteria specify a periapical (not panoramic) taken within one year of the prep, Aetna takes only duplicates that are unannotated and less than 36 months old, and Cigna pays when the evidence confirms decay or fracture too extensive for a filling. Aetna additionally qualifies a full crown on one of three clinical cases — 50% or more structural loss, an existing restoration covering half the tooth that needs replacing, or an endodontically treated tooth — excludes crowns placed strictly for cosmetic reasons, and may decline a tooth whose clinical crown is carious at or below the osseous crest. Replacement crowns also need the prior placement date and the reason for replacement. Confirm the current rule in the payer's own policy document linked on this page.

Dentovio

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Dentovio

Billing & claims · Records verified 2026-08-29 – 2026-08-30

Crowns (D2710–D2799) — payer documentation requirements

The published crown rules converge on one requirement: a current, dated pre-operative radiograph. Each payer's full rule is below.

Full-coverage restorations, including ceramic crowns billed under D2740. CDT codes referenced by number only.

Why these claims get denied

Crown claims fail when the pre-operative radiograph is missing, undated, or panoramic-only, when the submitted evidence does not show enough structural loss to rule out a filling, or when a replacement crown lacks the prior placement date and reason.

Aetna

Public — no login

Aetna's 2025 claim-documentation guidelines gate a full crown on one of three clinical qualifying cases, exclude crowns placed strictly for cosmetic reasons, and set an age and format standard for the radiographs submitted with any claim.

At least one of: 50% or more of the tooth structure lost to decay or fracture affecting the incisal angles or undermining at least one posterior cusp with a compromised marginal ridge; an existing restoration encompassing half or more of the tooth structure that needs replacing for extensive recurrent decay or fracture; or a tooth that has been endodontically treated
Crowns strictly for cosmetic reasons are not covered — the guidelines name diastema or gap closure, tooth misalignment and colour match
Restorative services may not be covered for a tooth with a poor or questionable prognosis due to poor restorability or carious destruction of the clinical crown at or below the osseous crest
Submitted radiographs should be duplicates, unannotated and unmarked, and less than 36 months old
For unique cases with extenuating circumstances, submit a narrative — the guidelines name it as the route round the cosmetic exclusion

Verified 2026-08-30 · read from

Aetna Dental and Oral Surgery Claim Documentation Guidelines, last updated July 21, 2025 (PDF)

Cigna

Public — no login

Cigna's REST-03 allows crowns when the submitted information confirms extensive decay or fracture that cannot be restored with amalgam or composite resin filling material.

Submitted information must confirm extensive decay or fracture of the tooth
The tooth must not be restorable with an amalgam or composite resin filling

Verified 2026-08-29 · read from

Cigna Dental Clinical Coverage Determination Guidelines — DPPO, 2026 edition, doc 928339 (PDF)

Delta Dental (Delta Dental Ins. enterprise)

Public — no login

Delta Dental Ins. clinical criteria require a pre-operative periapical radiograph taken within one year of the crown prep showing the tooth's endodontic and periodontal state, plus photographs, with detailed qualification criteria including majority structural loss and cracked-tooth narrative rules.

Pre-operative periapical radiograph (not panoramic) taken within one year of the crown preparation, showing the endodontic and periodontal state of the tooth
Photographs supporting the qualification criteria
Detailed crown qualification criteria, including greater-than-50% structural loss and cracked-tooth-syndrome narrative rules

Verified 2026-08-29 · read from

Delta Dental Ins. Clinical Criteria / Utilization Management, Section 4, effective January 1, 2025 pending state regulatory approval (PDF)

Guardian

Public — no login

Guardian's 2026 guidelines may require current pre-operative diagnostic radiographs and allow an indirect restoration when documentation shows decay or injury that cannot be restored with a direct filling.

Radiographs must be pre-operative, diagnostic-quality, and taken within 24 consecutive months of the date of service
Documentation must show decay or injury that cannot be restored with a direct filling
The guidelines list as usual qualifying cases: 50% or more of a cusp, incisal edge, or overall tooth structure decayed or completely fractured (missing); an endodontically treated posterior tooth; or cracked-tooth syndrome documented with clinical testing or symptoms
Replacement claims need documentation that the existing restoration has lost integrity through damage, fracture, recurrent decay, or resulting periodontal pathology

Published threshold: The record must support why a direct restoration is insufficient; the guidelines list 50% structural involvement and other documented conditions as common qualifying examples

Verified 2026-08-29 · read from

Guardian Dental Clinical Guidelines 2026, updated August 12, 2026 (PDF)

DentaQuest (Medicaid/CHIP administrator)

Public — no login

DentaQuest's Colorado ORM (§15.07) sets numeric cast-crown criteria: molars need 4+ surfaces and 2+ cusps destroyed, bicuspids 3+ surfaces and 1+ cusp, anteriors 4+ surfaces and 50%+ of the incisal edge, with cracked-tooth-syndrome documentation rules.

Scope: DentaQuest's Colorado Health First Medicaid program.

Molars: 4 or more surfaces and 2 or more cusps destroyed
Bicuspids: 3 or more surfaces and at least 1 cusp destroyed
Anteriors: 4 or more surfaces and 50% or more of the incisal edge destroyed
Cracked-tooth-syndrome claims follow the ORM's documentation rules

Verified 2026-08-29 · read from

DentaQuest Colorado Health First Medicaid Office Reference Manual, updated July 1, 2026 (PDF)

Other payer records without an extracted rule for this procedure

An absent record does not mean the payer has no policy. It means Dentovio has not extracted a rule for this procedure from that payer's material — and in several cases a verifier read the payer's public criteria in full and found no entry for the code, which is recorded in that payer's notes below rather than invented as a rule.

Delta Dental of New Jersey — Public — no login. Delta Dental of New Jersey is a separate member company from the Delta Dental Insurance enterprise recorded above — do not read one company's criteria onto the other. The handbook edition Dentovio read is the 2023 participating-dentist edition; confirm a newer edition before relying on it, and confirm the group's own contract, which the handbook says can vary. Delta Dental of New Jersey Participating Dentist Handbook, 2023 edition (PDF)
Delta Dental of Arkansas (Delta Dental Smiles, Arkansas Medicaid) — Public — no login. This record covers Arkansas Medicaid only and is a different member company from the two Delta Dental records above. The manual carries no confidentiality marking. Children's and adult exclusion wording differ in places and must not be quoted for one another. Delta Dental Smiles Provider Manual V12, Delta Dental of Arkansas (PDF)
MetLife — Provider portal login required. MetLife is the one payer here whose criteria Dentovio cannot read: the provider portal is credential-gated and the official public copy of the resource manual was unavailable on every attempt, so no scaling, crown or post-and-core rule is published under MetLife's name here. The one record that exists comes from a plan sponsor's summary plan description, not from MetLife's own policy library, and is scoped that way. An absent MetLife record means Dentovio could not read the document, never that MetLife has no rule. MetLife dental provider portal (current criteria; single sign-on required)
United Concordia — Public — no login. United Concordia's clinical policy is public, not portal-gated — what is gated is a different artifact, the commercial Dentist Reference Guides. The policy is stamped proprietary and prohibits dissemination beyond limited individual-use copying, so Dentovio paraphrases and links rather than reproducing it. Localized antimicrobial delivery is genuinely absent from the public PPO policy. Rules read from the DE/PA/WV Medical Assistance guide are state Medicaid program rules and do not describe a commercial PPO patient's plan, and United Concordia states that where its policy conflicts with the member's benefit plan, the plan governs. United Concordia Dental Clinical Policy (PPO), last update 5.1.26 — public behind a no-login acknowledgement (PDF)
MCNA Dental (Medicaid/CHIP administrator) — Public — no login. MCNA's Texas book is a children's Medicaid (Texas Health Steps / EPSDT) and CHIP dental plan covering birth through age 20. It contains no adult benefit rows at all, so it cannot support any statement about adults 21 and over — Texas adult dental sits outside MCNA entirely. The manual is public and carries no confidentiality marking. Every listed limit is an EPSDT floor that can be exceeded with a prior authorization documenting medical necessity, and the Medicaid and CHIP chapters carry different rules for the same codes. MCNA Texas Medicaid and CHIP Provider Manual v1.31, effective March 1, 2026

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Billing & claims · Records verified 2026-08-29 – 2026-08-30

Crowns (D2710–D2799) — payer documentation requirements

The published crown rules converge on one requirement: a current, dated pre-operative radiograph. Each payer's full rule is below.

Full-coverage restorations, including ceramic crowns billed under D2740. CDT codes referenced by number only.

Why these claims get denied

Aetna

Public — no login

At least one of: 50% or more of the tooth structure lost to decay or fracture affecting the incisal angles or undermining at least one posterior cusp with a compromised marginal ridge; an existing restoration encompassing half or more of the tooth structure that needs replacing for extensive recurrent decay or fracture; or a tooth that has been endodontically treated
Crowns strictly for cosmetic reasons are not covered — the guidelines name diastema or gap closure, tooth misalignment and colour match
Restorative services may not be covered for a tooth with a poor or questionable prognosis due to poor restorability or carious destruction of the clinical crown at or below the osseous crest
Submitted radiographs should be duplicates, unannotated and unmarked, and less than 36 months old
For unique cases with extenuating circumstances, submit a narrative — the guidelines name it as the route round the cosmetic exclusion

Verified 2026-08-30 · read from

Aetna Dental and Oral Surgery Claim Documentation Guidelines, last updated July 21, 2025 (PDF)

Cigna

Public — no login

Cigna's REST-03 allows crowns when the submitted information confirms extensive decay or fracture that cannot be restored with amalgam or composite resin filling material.

Submitted information must confirm extensive decay or fracture of the tooth
The tooth must not be restorable with an amalgam or composite resin filling

Verified 2026-08-29 · read from

Cigna Dental Clinical Coverage Determination Guidelines — DPPO, 2026 edition, doc 928339 (PDF)

Delta Dental (Delta Dental Ins. enterprise)

Public — no login

Pre-operative periapical radiograph (not panoramic) taken within one year of the crown preparation, showing the endodontic and periodontal state of the tooth
Photographs supporting the qualification criteria
Detailed crown qualification criteria, including greater-than-50% structural loss and cracked-tooth-syndrome narrative rules

Verified 2026-08-29 · read from

Delta Dental Ins. Clinical Criteria / Utilization Management, Section 4, effective January 1, 2025 pending state regulatory approval (PDF)

Guardian

Public — no login

Radiographs must be pre-operative, diagnostic-quality, and taken within 24 consecutive months of the date of service
Documentation must show decay or injury that cannot be restored with a direct filling
The guidelines list as usual qualifying cases: 50% or more of a cusp, incisal edge, or overall tooth structure decayed or completely fractured (missing); an endodontically treated posterior tooth; or cracked-tooth syndrome documented with clinical testing or symptoms
Replacement claims need documentation that the existing restoration has lost integrity through damage, fracture, recurrent decay, or resulting periodontal pathology

Published threshold: The record must support why a direct restoration is insufficient; the guidelines list 50% structural involvement and other documented conditions as common qualifying examples

Verified 2026-08-29 · read from

Guardian Dental Clinical Guidelines 2026, updated August 12, 2026 (PDF)

DentaQuest (Medicaid/CHIP administrator)

Public — no login

Scope: DentaQuest's Colorado Health First Medicaid program.

Molars: 4 or more surfaces and 2 or more cusps destroyed
Bicuspids: 3 or more surfaces and at least 1 cusp destroyed
Anteriors: 4 or more surfaces and 50% or more of the incisal edge destroyed
Cracked-tooth-syndrome claims follow the ORM's documentation rules

Verified 2026-08-29 · read from

DentaQuest Colorado Health First Medicaid Office Reference Manual, updated July 1, 2026 (PDF)

Other payer records without an extracted rule for this procedure

Delta Dental of New Jersey — Public — no login. Delta Dental of New Jersey is a separate member company from the Delta Dental Insurance enterprise recorded above — do not read one company's criteria onto the other. The handbook edition Dentovio read is the 2023 participating-dentist edition; confirm a newer edition before relying on it, and confirm the group's own contract, which the handbook says can vary. Delta Dental of New Jersey Participating Dentist Handbook, 2023 edition (PDF)
Delta Dental of Arkansas (Delta Dental Smiles, Arkansas Medicaid) — Public — no login. This record covers Arkansas Medicaid only and is a different member company from the two Delta Dental records above. The manual carries no confidentiality marking. Children's and adult exclusion wording differ in places and must not be quoted for one another. Delta Dental Smiles Provider Manual V12, Delta Dental of Arkansas (PDF)
MetLife — Provider portal login required. MetLife is the one payer here whose criteria Dentovio cannot read: the provider portal is credential-gated and the official public copy of the resource manual was unavailable on every attempt, so no scaling, crown or post-and-core rule is published under MetLife's name here. The one record that exists comes from a plan sponsor's summary plan description, not from MetLife's own policy library, and is scoped that way. An absent MetLife record means Dentovio could not read the document, never that MetLife has no rule. MetLife dental provider portal (current criteria; single sign-on required)
United Concordia — Public — no login. United Concordia's clinical policy is public, not portal-gated — what is gated is a different artifact, the commercial Dentist Reference Guides. The policy is stamped proprietary and prohibits dissemination beyond limited individual-use copying, so Dentovio paraphrases and links rather than reproducing it. Localized antimicrobial delivery is genuinely absent from the public PPO policy. Rules read from the DE/PA/WV Medical Assistance guide are state Medicaid program rules and do not describe a commercial PPO patient's plan, and United Concordia states that where its policy conflicts with the member's benefit plan, the plan governs. United Concordia Dental Clinical Policy (PPO), last update 5.1.26 — public behind a no-login acknowledgement (PDF)
MCNA Dental (Medicaid/CHIP administrator) — Public — no login. MCNA's Texas book is a children's Medicaid (Texas Health Steps / EPSDT) and CHIP dental plan covering birth through age 20. It contains no adult benefit rows at all, so it cannot support any statement about adults 21 and over — Texas adult dental sits outside MCNA entirely. The manual is public and carries no confidentiality marking. Every listed limit is an EPSDT floor that can be exceeded with a prior authorization documenting medical necessity, and the Medicaid and CHIP chapters carry different rules for the same codes. MCNA Texas Medicaid and CHIP Provider Manual v1.31, effective March 1, 2026