D2790 Dental Code: Full Cast High Noble Metal Crown (Billing Guide 2026)

Reviewed by Morgan Heminger · Updated September 23, 2026

What Is D2790? (CDT Code Overview)

CDT code D2790 is the dental procedure code for a full cast high noble metal crown: an all-metal crown made from a high noble alloy (at least 60% noble metal, including at least 40% gold), which is what most offices mean by a gold crown. It belongs to the Restorative category of CDT codes (Crowns, Single Restorations Only subcategory). If you need the gold crown dental code or ADA code, this is it; full cast crowns in predominantly base metal are D2791 and in noble metal D2792.

When Should You Use D2790?

The D2790 dental code applies to the placement of a complete cast high noble metal crown. This CDT code should be selected when a tooth needs full coverage protection due to significant decay, structural damage, or following root canal therapy, and when high noble metal materials (like gold or platinum alloys) are selected for their strength and biocompatibility. Apply D2790 exclusively when the clinical conditions warrant this treatment and the crown is made entirely from high noble metal materials, excluding porcelain-fused or base metal options. Correct code usage ensures proper reimbursement and adherence to insurance guidelines.

Quick reference: Use D2790 when the clinical scenario specifically matches full cast high noble metal crown. Do not use this code as a substitute for related procedures in the same category. Consider whether D2710 (Resin-Based Crown Billing) or D2712 (3/4 Resin-Based Crown) might be more appropriate instead.

D2790 vs. Similar CDT Codes: Key Differences

Dental teams frequently confuse D2790 with other codes in the crowns (single restorations, cont.) range. Here is how D2790 differs from the most commonly mixed-up codes:

Documentation Requirements for D2790

Proper record-keeping is vital when submitting claims for D2790. Dental practices must verify that patient records contain:

• Comprehensive clinical documentation describing decay extent, damage, or structural compromise
• Pre-treatment radiographic images demonstrating tooth condition
• Clinical photographs (when available) providing visual documentation
• Material choice documentation confirming high noble metal use

Typical clinical applications include:

• A posterior tooth with significant decay affecting cusp integrity
• An endodontically treated tooth needing complete protection
• Replacement of a failed high noble metal crown due to deterioration or secondary decay

Complete record-keeping validates treatment necessity and reduces claim rejection risks.

Documentation checklist for D2790:

• Patient chief complaint and relevant medical/dental history clearly recorded.
• Clinical findings that support the use of D2790 specifically (not a more general or more specific code).
• Any diagnostic tests, imaging, or supplementary data that justify the procedure.
• Treatment plan with rationale connecting the diagnosis to the procedure coded as D2790.
• Post-procedure notes, including outcomes and follow-up recommendations.

For a deeper look at documentation best practices, see our guide on How to Improve Dental Charting Practices.

Insurance and Billing Guide for D2790

For optimal reimbursement and reduced processing delays when submitting D2790 claims:

1. Confirm benefits: Prior to treatment, validate that the patient's insurance includes high noble metal crown coverage and review any frequency restrictions or replacement policies.
2. Include supporting materials: Always attach clinical documentation, radiographic images, and photographs with claims. Clearly specify high noble metal usage in treatment notes.
3. Apply correct coding: Avoid using D2790 in place of other crown procedures, such as porcelain-fused-to-metal restorations or full cast noble metal restorations. Every code has distinct requirements.
4. Review benefit statements: Examine Explanation of Benefits documents for payment discrepancies or rejections. When claims are denied, analyze the carrier's explanation and prepare appeals with supplementary documentation when needed.
5. Manage receivables: Maintain accounts receivable oversight by pursuing pending claims within 30 days of initial submission.

Effective payer communication and thorough documentation facilitate successful claim resolution.

Common denial reasons for D2790: Lack of clinical documentation, frequency limitations exceeded, code mismatch with diagnosis, or missing prior authorization. When appealing a denied D2790 claim, include a detailed narrative explaining why the procedure was necessary, supporting clinical evidence, and relevant imaging or test results. Many practices find that well-documented first submissions dramatically reduce the need for appeals.

What major payers publish about D2790:

• Aetna covers a crown when the tooth has lost at least half its structure to decay or fracture, has a failing restoration covering at least half the tooth, or has had root canal treatment. Send current dated pre-op X-rays; crowns for wear or cosmetic reasons are not covered under most plans (Aetna Claim Documentation Guidelines, July 2025).
• UnitedHealthcare needs a current dated pre-op X-ray of the tooth and a rationale when replacing a crown. If decay is not visible, add a narrative or treatment records, and for cracked tooth syndrome list the diagnostic tests performed (UnitedHealthcare Dental Claim Review Guidelines, January 2026).
• Cigna allows a replacement crown only when the existing one is unserviceable, and does not allow crowns for wear, to increase vertical dimension or for cosmetics (Cigna Dental Coverage Determination Guidelines, 2026).
• Delta Dental of Virginia treats a crown as optional unless the tooth cannot be restored with a filling, in which case it pays the filling as an alternate benefit, and denies crowns for children under 12. A pre-op periapical X-ray is required (Delta Dental of Virginia Participating Dentists' Handbook, 2026).

These are the payers' published policy documents; the patient's own plan can set different frequencies and alternate benefits, so confirm them during insurance verification.

To improve your overall claims workflow, explore How to Determine Primary and Secondary Insurance for Dental Coordination of Benefits.

Real-World Case Example: Billing D2790

A patient presents requiring a procedure consistent with D2790 (full cast high noble metal crown). The treating dentist documents the clinical findings, performs the procedure as indicated, and records detailed notes including the diagnosis, technique, and outcome. The billing team verifies insurance coverage, submits the claim with D2790 and supporting documentation, and follows up to ensure timely reimbursement. When the initial claim is processed, the practice reviews the Explanation of Benefits and addresses any discrepancies promptly.

Related CDT Codes to D2790

If you are researching D2790, you may also need to reference these related CDT codes in the crowns (single restorations, cont.) range and beyond:

• D2140: Amalgam Restoration Guide — Learn when to use D2140 and how it differs from D2790.
• D2150: Two-Surface Amalgam Restoration — Learn when to use D2150 and how it differs from D2790.
• D2330: Anterior Composite Restorations — Learn when to use D2330 and how it differs from D2790.
• D2331: Anterior Composite Restoration — Learn when to use D2331 and how it differs from D2790.
• D2410: Gold Foil Restorations — Learn when to use D2410 and how it differs from D2790.

Frequently Asked Questions About D2790

What qualifies as a high noble metal for D2790 dental crowns?

High noble metal for D2790 crowns refers to dental alloys containing a minimum of 60% noble metals (including gold, platinum, and palladium), with gold comprising at least 40% of the total composition. These premium metals are selected for their exceptional durability, outstanding corrosion resistance, and superior biocompatibility with oral tissues. Always verify with the specific insurance carrier, as policies and coverage rules can vary significantly between payers. Maintaining thorough documentation for D2790 will strengthen your position in any audit or appeal scenario.

Is D2790 appropriate for use on primary teeth?

D2790 is generally not recommended for primary teeth due to the significant cost and extended lifespan of high noble metal crowns. For baby teeth, alternative codes like D2930 (stainless steel crown) are more appropriate and widely accepted by insurance providers. Always verify with the specific insurance carrier, as policies and coverage rules can vary significantly between payers. Maintaining thorough documentation for D2790 will strengthen your position in any audit or appeal scenario.

What alternatives exist for patients who cannot afford high noble metal crowns?

Patients unable to afford high noble metal crowns have several alternatives available, including porcelain-fused-to-metal crowns (D2750) and all-ceramic crowns (D2740). Each option offers different characteristics and pricing, and the corresponding CDT code must be used for proper insurance claim processing. Always verify with the specific insurance carrier, as policies and coverage rules can vary significantly between payers. Maintaining thorough documentation for D2790 will strengthen your position in any audit or appeal scenario.

What is the typical reimbursement range for D2790?

2026 Medicaid fee schedules give a public reference point for D2790: New York Medicaid pays $505.00 for patients 6 and older with prior authorization (New York Medicaid dental fee schedule, January 2026) and Texas Medicaid pays $534.93 for patients 13 to 20 (Texas Medicaid (TMHP) THSteps dental fee schedule). D2790 is not a covered, separately priced service on the Medi-Cal Dental or Florida Medicaid fee schedules. Commercial PPO reimbursement depends on the payer contract, your region and network status, so the most reliable number for your practice is the allowed amount on your recent EOBs for D2790.

Does D2790 require prior authorization?

Prior authorization requirements for D2790 depend on the patient's specific insurance plan. Some carriers require advance approval for procedures coded under D2790, while others process claims without it. Best practice is to verify authorization requirements during insurance eligibility checks before the appointment. If prior authorization is required, submit the request with detailed clinical notes and supporting documentation to avoid delays in patient care and claim processing.