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Dental teams handle dozens of procedure codes weekly, but crown placements remain among the most technically detailed and documentation-heavy services in restorative dentistry. Getting D2790 right protects revenue, prevents claim denials, and keeps patient expectations clear. This guide covers clinical applications, billing requirements, and common documentation mistakes for D2790. You'll learn when to use this code, what insurers expect, and how to avoid the errors that lead to delayed reimbursement.
Nov 1, 2025
What is Dental Code D2790?
D2790 describes a full crown—also called a complete coverage restoration. This procedure covers the entire visible portion of a tooth above the gumline, restoring form, function, and sometimes appearance after extensive decay, fracture, or failed restorations.
Crowns coded under D2790 use various materials: high noble metal, predominantly base metal, or noble metal. The material choice depends on tooth location, patient needs, and insurance limitations. Unlike other crown codes that specify resin or porcelain fused to metal, D2790 captures full-metal restorations primarily used for posterior teeth where strength matters more than visibility.
Common Terminology
You'll encounter these terms when documenting or discussing D2790 procedures:
High noble metal crown: Contains at least 60% noble metal content, including a minimum of 40% gold
Predominantly base metal crown: Made mostly of non-noble metals like nickel-chromium or cobalt-chromium alloys
Noble metal crown: Composed of at least 25% noble metal but doesn't meet high noble thresholds
Complete coverage restoration: Any crown that encircles the entire clinical portion of a tooth
Indirect restoration: A restoration fabricated outside the mouth, typically in a dental laboratory
When is D2790 Used?
D2790 applies when a tooth requires full coverage with a metal crown. These situations typically involve molars or premolars where chewing forces demand maximum strength and esthetics matter less than durability.
Common Clinical Scenarios
Full metal crowns serve specific clinical needs where other materials would fail:
Extensive decay that compromises more than half the tooth structure and leaves insufficient enamel for onlays or inlays
Fractured teeth with cracks extending below the gumline or through the pulp chamber
Root canal treated molars needing reinforcement against future fracture
Severe wear from bruxism that threatens tooth integrity
Failed large amalgam or composite restorations where replacement crowns offer better long-term prognosis
Bridge abutment preparation requiring maximum retention and resistance form
When D2790 is NOT Appropriate
Certain clinical situations call for different codes or treatment approaches:
Teeth requiring porcelain or resin for esthetic reasons should use D2751 or D2752 instead
Minimal decay or small fractures that qualify for onlays under D2643 or D2644
Temporary crowns during the fabrication period, which fall under D2799
Crown buildups or post and core foundations, separately coded as D2950 or D2952
Teeth with insufficient remaining structure requiring extraction rather than restoration
Billing and Insurance Considerations
Crown procedures generate significant revenue but also invite scrutiny from insurance carriers. Documentation gaps, coding errors, or timing issues can delay payment by weeks or trigger outright denials that require lengthy appeals.
Documentation Requirements
Insurance companies won't approve D2790 claims without proof of clinical necessity. Your records must show why the crown was medically required, not elective:
Progress notes describing the extent of decay, fracture lines, or restoration failure with measurements and affected surfaces
Periodontal charting showing adequate bone support and healthy surrounding tissue
Treatment planning notes explaining why less invasive options weren't suitable
Informed consent forms signed by the patient acknowledging the procedure, risks, and alternatives
Radiographic documentation strengthens claims and reduces the chance of post-payment audits. Pre-operative radiographs establish baseline conditions and justify the treatment decision. Bitewing or periapical films should clearly show decay extending beyond what direct restorations can address, fracture lines compromising tooth structure, or existing restorations with recurrent decay or marginal breakdown.
Insurance Coverage
Most dental plans categorize crowns as major restorative procedures with different coverage rates than basic services:
PPO plans typically cover 50% of the allowed amount after deductibles, though percentages vary by contract
Waiting periods often apply to new policies, ranging from six to twelve months before major services receive benefits
Annual maximum limits affect coverage when patients need multiple crowns within the same benefit year
Pre-authorization requirements from many carriers before beginning treatment, with decisions taking 10-15 business days
Downgrading policies where insurers pay based on less expensive alternatives like amalgam buildups rather than the crown itself
Common Billing Mistakes
Small errors in coding or timing create unnecessary claim rejections:
Billing D2790 for temporary crowns instead of using D2799 for provisional restorations
Submitting claims before the permanent crown is seated rather than waiting for delivery and cementation
Failing to wait the required five-year replacement period before billing a new crown on the same tooth
Bundling crown buildups or core buildups into the crown fee rather than separating them as D2950 or D2952
Using incorrect tooth numbers or surfaces in claim forms, especially when replacing existing crowns
Missing narrative descriptions on pre-authorization requests that explain why the crown is necessary
Not accounting for insurance downgrades that reimburse at lower fee schedules than submitted
Common Questions
How often can D2790 be billed for the same tooth?
Most insurance plans enforce a five-year waiting period between crown replacements on the same tooth. Carriers view crowns as long-term restorations that shouldn't require frequent replacement. You can override this limitation if you document clear reasons for early failure—like new decay under margins, fracture from trauma, or preparation for a bridge abutment. Without documented justification, insurers will deny claims as premature and patients become responsible for full payment.
What's the difference between D2790 and D2791?
D2790 covers full cast high noble metal crowns, while D2791 describes full cast predominantly base metal crowns. The distinction matters because base metal alloys cost less than high noble materials containing significant gold content. Many insurance carriers reimburse D2791 at lower rates than D2790 based on material costs. Always code based on the actual laboratory-fabricated crown material, not the fee you want to charge.
Can I bill D2790 and D2950 on the same date of service?
Yes, when clinically necessary. D2950 covers core buildups required to restore adequate tooth structure before crown preparation. These codes address different procedures: the buildup replaces missing tooth structure while the crown provides complete coverage. Submit both codes with clear documentation showing why the buildup was needed. Some insurers bundle these procedures, paying only for the crown, but most will reimburse both if your notes justify the additional work.
Do I need radiographs for every D2790 claim?
Pre-operative radiographs aren't always mandatory for claim submission, but they dramatically reduce denial rates and audit risk. Bitewings or periapicals taken within six months of treatment show the tooth's condition before crown preparation. If an insurer questions medical necessity six months after treatment, radiographic evidence protects your practice from payback demands. Take films, document findings, and include them with pre-authorization requests.
What happens if insurance downgrades my D2790 claim?
Insurance downgrades pay benefits based on less expensive alternatives rather than the treatment you provided. If your patient needed a full crown but the carrier believes an amalgam restoration would have sufficed, they'll reimburse at the amalgam fee schedule. Your practice absorbs the difference unless you collected accurate estimates upfront. Prevent downgrades by submitting detailed pre-authorizations with radiographs and narratives explaining why less invasive options weren't viable. When downgrades occur despite solid documentation, appeal with additional clinical justification.
Can I code a gold crown as D2790?
Yes, if it contains at least 60% noble metal with a minimum 40% gold content. These high noble alloy crowns fall under D2790. If the gold content is lower—between 25% and 60% noble metal—code it as a noble metal crown under a different classification. Always verify laboratory reports listing exact alloy composition to code accurately. Incorrect coding based on assumptions rather than lab documentation creates compliance issues during audits.
Keep Your Schedule Full While Managing Crown Cases
Crown procedures demand precision in both treatment and documentation. Between pre-authorizations, radiograph requirements, and claim appeals, administrative tasks can pull your team away from patient care. When unexpected staff absences hit during high-volume crown weeks, scheduling gaps and documentation delays follow.
Teero connects your practice with qualified dental hygienists who can maintain your preventive care schedule while your core team handles complex restorative cases. Fill shifts quickly through the app without disrupting crown appointments or rushing through documentation. Your temporary team members arrive ready to work, fully licensed, and covered under comprehensive malpractice and workers' compensation insurance.
Sign up today to see how Teero keeps your practice fully staffed during your busiest restorative treatment weeks.