D2740 - Crown (Porcelain)
Crown - porcelain/ceramic.
- Procedure Code
- D2740
- Category
- Restorative
Insurance Verification Benchmarks & Billing Guidelines
Benchmark Policy Source: Delta Dental National / PPO Standard
- Frequency Limitation
- 1 per tooth every 5 years (60 months) - some carriers 7 years (84 months) (ROLLING_MONTHS)
- Age Limitation
- Adult permanent dentition. Excluded for primary teeth.
Required Claim Attachments & Pre-Submission Checklist
- Pre-operative periapical radiograph showing decay or breakdown
- Narrative detailing missing tooth structure (>50%) or cracked tooth syndrome
- Core buildup (D2950) documentation if performed
Bill When (Allowable Clinical Criteria)
- Tooth has lost 50% or more of clinical crown structure due to extensive decay or fracture
- Endodontically treated posterior tooth requiring coronal protection
Restrictions & Clinical Exclusions
- Do NOT bill for cosmetic reasons alone
- Do NOT bill on teeth with unrestorable periodontal prognosis
Common Claim Denial Codes & Overturn Strategies
| Denial Code | Denial Reason | Appeal & Overturn Strategy |
|---|---|---|
| CO-50 | Lacks medical necessity (radiograph shows insufficient breakdown) | Submit pre-op intraoral photos proving cracked cusps, undermining decay, or completed root canal. |
| CO-119 | Replacement within 5-year clause | Provide previous placement date if placed by another office more than 5 years ago. |
ICD-10 Justification & Crosswalk Mappings
| ICD-10 Code | Diagnosis Name | Category | Primary Justification | Claim Type | Clinical Scenario |
|---|---|---|---|---|---|
| K02.63 | Dental caries on smooth surface penetrating into pulp | Dental caries | Yes (Primary) | BOTH | crown – porcelain/ceramic indicated for Dental caries on smooth surface penetrating into pulp |
| K00.2 | Abnormalities of size and form of teeth | Disorders of tooth development and eruption | Secondary | BOTH | crown – porcelain/ceramic indicated for Abnormalities of size and form of teeth |
| K02.52 | Dental caries on pit and fissure surface penetrating into dentin | Dental caries | Secondary | BOTH | crown – porcelain/ceramic indicated for Dental caries on pit and fissure surface penetrating into dentin |
| K02.53 | Dental caries on pit and fissure surface penetrating into pulp | Dental caries | Secondary | BOTH | crown – porcelain/ceramic indicated for Dental caries on pit and fissure surface penetrating into pulp |
| K02.62 | Dental caries on smooth surface penetrating into dentin | Dental caries | Secondary | BOTH | crown – porcelain/ceramic indicated for Dental caries on smooth surface penetrating into dentin |
| S02.5XXA | Fracture of tooth (traumatic), initial encounter for closed fracture | Fracture of skull and facial bones | Secondary | BOTH | crown – porcelain/ceramic indicated for Fracture of tooth (traumatic), initial encounter for closed fracture |