# Core buildup (D2950) — payer documentation requirements > What documentation do dental payers require for core buildup (D2950) claims? The published rules, payer by payer, with a direct link to every source document. URL: https://dentovio.com/dental-claim-documentation/d2950-core-buildup 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 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. ## Why these claims get denied 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. ## Requirements by payer No major payer publishes standalone public criteria for this code — the bundling decision is adjudicated against the crown evidence, so the governing published criteria below are the payers' crown rules. ### 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)