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All about CDT D2740 Dental Procedure Code Billing Questions

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CDT D2740 Dental Procedure Code 

Few facts about this dental procedure code while submitting the insurance claim: 

  • This D2740 is the esthetic full-coverage crown reporting porcelain/ceramic dental procedures. With this dental procedure code, a prosthetic crown placed over a chipped, cracked, damaged, or decayed tooth yields positive cosmetic results. 
  • When considering the dental claim about the full-coverage crown, the insurers refer to the patient’s benefits plan, limitations, and exclusions. 
  • Dental PPO plans will reimburse for the prosthetic porcelain/ceramic crown fitted over the tooth within the smile zone. Porcelain crowns are lighter than the ceramic and give a more natural look. 
  • Most PPO dental plans limit the reimbursement for a crown replacement to every ten years, irrespective of the material used. 
  • If you are an in-network provider, in that case, you can charge the patient the difference between the contract rate for ceramic and paid rate. 
  • For the in-network PPO dental plan, include the seat date and not the prep date for the reimbursement. 
  • Charging an additional fee for a crown upgrade is not acceptable for PPO plans. The provider can bill for the rendered service supported by the documents, narrative and miscellaneous code. As it is an out-of-pocket payment for the patient, be very clear with all the details about the material and what is different from the covered service. 
  • Most PPO dental plans will not reimburse for the ceramic/porcelain crown placed in the rear/posterior region of the mouth. 
  • The revision in the codes from 2018 has removed the word substrate to eliminate the confusion of application to zirconium crowns. D2740 will reimburse for porcelain/ceramic crowns and not the zirconium. 
  • When using the dental code D2740, if tooth decay is not visible on the x-ray, that can be documented with a narrative indicating the location of the tooth decay. 
  • To smooth the process of coverage and payment, submitting the claim with x-rays is not enough. 
  • Also, for root-canal treatment, supporting information like an endo report with post-op x-ray indicate the completion of endo treatment. 
  • The claim form always has the pre-op and post-op x-rays to accommodate the procedure. 

How much does a prosthetic crown cost? 

As per ADA code D2740, the regular fee for the procedure is $1,168. The covered service depends upon the plan and its benefits, although if you want to upgrade from a full cast-metal to a porcelain crown, your patient has to pay the cost difference if not included in their plan.