Billing & claims · Last verified 2026-08-28
Building up a broken-down tooth so a crown can be retained on it. CDT codes referenced by number only.
Core buildup (D2950) is the classic bundled denial: payers fold it into the crown fee unless pre-operative evidence shows the tooth lost enough structure to need a separate buildup — and no major payer publishes standalone public D2950 criteria, so the bundling decision is adjudicated against the published crown rules (Delta Dental Ins.: a pre-operative periapical within one year of the prep plus photos and structural-loss qualification; Cigna: evidence of decay or fracture beyond a filling; DentaQuest Colorado: numeric surface-and-cusp destruction counts). Capture the pre-operative photo and radiograph before preparing the tooth — after the prep, a bundling denial is rarely winnable.
Payers routinely bundle D2950 into the crown fee. Without pre-operative evidence that the tooth lost enough structure to need a separate buildup, the bundle is usually final — this is the classic denial that documentation must prevent at submission, because it is rarely winnable afterward.
The bundling decision is adjudicated against the crown evidence, so the governing published criteria below are the payers' crown rules — the pre-operative radiograph and structural-loss standards that determine whether a separate buildup benefit survives review.
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.
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.
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.
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.
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.
DentaQuest Colorado Health First Office Reference Manual (PDF)DentaQuest Indiana ORM via Humana (PDF)DentaQuest Kentucky Medicaid manual via Anthem (PDF)
