Crowns (D2710–D2799) — payer documentation requirements

Aetna's claim-documentation guidelines require current dated pre-operative radiographs for crowns D2710–D2799, plus the prior placement date and rationale for replacement crowns.

• •Current dated pre-operative radiographs for D2710–D2799
• •For replacement crowns: the prior placement date and the rationale for replacement

Aetna DCPB041 — Scaling and Root PlaningAetna Dental Clinical Policy Bulletins indexAetna Dental and Oral Surgery Claim Documentation Guidelines (PDF)

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

Cigna Dental Coverage Determination Guidelines — DPPO, 2026 edition (PDF)Cigna Dental Coverage Determination Guidelines — DHMO, 2026 edition (PDF)

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

Delta Dental Ins. Clinical Criteria / Utilization Management (PDF)Delta Dental Federal Government Programs Dental Office Handbook 2026 (PDF)Delta Dental of North Carolina — Dentist Handbook, January 1, 2026 (PDF)

MetLife's Preferred Dentist Program manual requires recent, dated preoperative X-rays for crowns D2710–D2799.

• •Recent, dated preoperative X-rays for D2710–D2799

MetLife Preferred Dentist Program Resource Manual (archived public PDF)MetLife dental provider portal (current rules; login required)

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.

• •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

DentaQuest Colorado Health First Office Reference Manual (PDF)DentaQuest Indiana ORM via Humana (PDF)DentaQuest Kentucky Medicaid manual via Anthem (PDF)