# Crowns (D2710–D2799) — payer documentation requirements

> What documentation do dental payers require for crowns (D2710–D2799) claims? The published rules, payer by payer, with a direct link to every source document.

URL: https://dentovio.com/dental-claim-documentation/d2740-crowns

Last verified: 2026-08-28

Dentovio is an independent publisher — not a dental payer, the ADA, or any state dental board. These summaries describe the payers' published clinical-review and documentation criteria; 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 is the American Dental Association's copyrighted code set and this page does not reproduce ADA descriptors.

## Direct answer

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 and MetLife require recent dated pre-op images, and Cigna pays when the evidence confirms decay or fracture too extensive for a filling. 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.

## 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.

## Requirements by payer

### Aetna

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

Sources:

- [Aetna DCPB041 — Scaling and Root Planing](https://www.aetna.com/health-care-professionals/clinical-policy-bulletins/dental-clinical-policy-bulletins/DCPB041.html)
- [Aetna Dental Clinical Policy Bulletins index](https://www.aetna.com/health-care-professionals/clinical-policy-bulletins/dental-clinical-policy-bulletins.html)
- [Aetna Dental and Oral Surgery Claim Documentation Guidelines (PDF)](https://www.aetna.com/content/dam/aetna/pdfs/families/Dental-Claim-Documentation-Guidelines.pdf)

### Cigna

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

Sources:

- [Cigna Dental Coverage Determination Guidelines — DPPO, 2026 edition (PDF)](https://campaigns.cigna.com/static/campaigns-cigna-com/docs/dental-hcpemails/Clinical%20Documents/Cigna%20Dental%20Coverage%20Determination%20Guidelines%20-%20DPPO%20-%202026%20-%20Final.pdf)
- [Cigna Dental Coverage Determination Guidelines — DHMO, 2026 edition (PDF)](https://static.cigna.com/assets/chcp/pdf/resourceLibrary/dental/CignaDentalCoverageDeterminationGuidelinesDHMO2026.pdf)

### Delta Dental (Delta Dental Ins. enterprise)

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

Sources:

- [Delta Dental Ins. Clinical Criteria / Utilization Management (PDF)](https://www1.deltadentalins.com/content/dam/ddins/en/pdf/dentists/provider-tools/clinical-criteria-utilization-management.pdf)
- [Delta Dental Federal Government Programs Dental Office Handbook 2026 (PDF)](https://www1.deltadentalins.com/content/dam/ddins/en/pdf/affiliate-sites/common/dental-office-handbook-2026.pdf)
- [Delta Dental of North Carolina — Dentist Handbook, January 1, 2026 (PDF)](https://deltadentalnc.com/hubfs/Delta%20Dental%20Dentist%20Handbook%202026.pdf)

### MetLife

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

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

Sources:

- [MetLife Preferred Dentist Program Resource Manual (archived public PDF)](https://web.archive.org/web/20230317041442/https://eforms.metlife.com/wcm8/PDFFiles/28922.pdf)
- [MetLife dental provider portal (current rules; login required)](https://www.metdental.com)

### DentaQuest (Medicaid/CHIP administrator)

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

Sources:

- [DentaQuest Colorado Health First Office Reference Manual (PDF)](https://www.dentaquest.com/content/dam/dentaquest/en/providers/colorado/co-health-first-office-reference-manual.pdf)
- [DentaQuest Indiana ORM via Humana (PDF)](https://www.dentaquest.com/content/dam/dentaquest/en/providers/indiana/in-humana-office-reference-manual.pdf.coredownload.inline.pdf)
- [DentaQuest Kentucky Medicaid manual via Anthem (PDF)](https://providers.anthem.com/docs/gpp/KY_CAID_DentaQuestManual.pdf)

## Payers without public criteria for this procedure

- United Concordia: Public — no login. Public provider-education documents and help-center policy pages, including a dedicated scaling-and-root-planing claims guide. Policy library: [United Concordia — Scaling and Root Planing Claims: Getting It Right (PDF)](https://www.unitedconcordia.com/content/dam/ucd/en/commercial/website/docs/transcripts/Scaling%20and%20Root%20Planing%20Claims%20Getting%20it%20Right.pdf)
- Guardian: Provider portal login required. Guardian publishes no open documentation criteria for SRP, crowns, or buildups. Treat any third-party summary of Guardian rules as unverified and confirm in the portal before relying on it. Policy library: [Guardian provider toolkit](https://www.guardianlife.com/providers/toolkit)
- MCNA Dental (Medicaid/CHIP administrator): Public — no login. MCNA's manuals are public and versioned, but Dentovio has not yet extracted MCNA's own per-procedure criteria text; use the state manual directly for D4341 and crown criteria. MCNA also points providers to the ADA's public SRP claims-submission guide. Policy library: [MCNA Texas Medicaid and CHIP Provider Manual](https://manuals.mcna.net/texas)

## Related

- [All payer documentation requirements](https://dentovio.com/dental-claim-documentation/index.html.md)
- [Dental claim denial codes](https://dentovio.com/dental-claim-denial-codes/index.html.md)
- [Dental insurance prompt-pay laws by state](https://dentovio.com/dental-prompt-pay-laws/index.html.md)