D2740 - Crown (Porcelain)
Crown - porcelain/ceramic.
- Procedure Code
- D2740
- Clinical Category
- Restorative
- Primary ICD-10 Justification
- K02.63 (Dental caries on smooth surface penetrating into pulp)
- Reference Fee & Claim Types
- BOTH
Insurance Verification Benchmarks & Billing Guidelines
Payer policy benchmarks, pre-submission attachment requirements, and denial prevention rules for D2740.
- Frequency Limitation
- 1 per tooth every 5 years (60 months) - some carriers 7 years (84 months) (ROLLING_MONTHS)
- Age Limitation Criteria
- 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-CM Justification & Crosswalk Mappings for D2740 (6)
Click any ICD-10-CM diagnosis code below to inspect its reverse procedure mappings and differential coding guide.
| 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 |
Frequently Asked Questions — D2740 (Crown (Porcelain))
Quick answers for dental billers and treatment coordinators submitting claims for D2740.
What ICD-10 diagnosis codes link to dental procedure D2740?▾
Common ICD-10-CM justification codes for CDT D2740 (Crown (Porcelain)) include: K02.63 - Dental caries on smooth surface penetrating into pulp (Primary); K00.2 - Abnormalities of size and form of teeth; K02.52 - Dental caries on pit and fissure surface penetrating into dentin; K02.53 - Dental caries on pit and fissure surface penetrating into pulp; K02.62 - Dental caries on smooth surface penetrating into dentin; S02.5XXA - Fracture of tooth (traumatic), initial encounter for closed fracture.
Can CDT code D2740 be billed to medical insurance?▾
Billing CDT D2740 (Crown (Porcelain)) to medical insurance depends on the underlying clinical necessity and trauma/pathology documentation. Supported claim types across linked diagnoses: BOTH.
What attachments and documentation are required for billing CDT D2740?▾
Required claim attachments for CDT D2740 (Crown (Porcelain)) include: Pre-operative periapical radiograph showing decay or breakdown; Narrative detailing missing tooth structure (>50%) or cracked tooth syndrome; Core buildup (D2950) documentation if performed.
What is the insurance frequency limitation for CDT D2740?▾
Standard commercial insurance frequency for D2740: 1 per tooth every 5 years (60 months) - some carriers 7 years (84 months) (ROLLING_MONTHS). Age criteria: Adult permanent dentition. Excluded for primary teeth..
What are common insurance denial reasons and appeal tips for CDT D2740?▾
Denial Code CO-50 (Lacks medical necessity (radiograph shows insufficient breakdown)): Overturn appeal strategy - Submit pre-op intraoral photos proving cracked cusps, undermining decay, or completed root canal. | Denial Code CO-119 (Replacement within 5-year clause): Overturn appeal strategy - Provide previous placement date if placed by another office more than 5 years ago.