Understanding Crowns and Buildups: How to Get Insurance to Pay for Both

Avoiding Bundling Denials and Getting Paid for the Work You Actually Do

If you’ve ever submitted a crown and buildup together—only to have insurance deny the buildup as “included” with the crown—you’re not alone. This scenario is incredibly common and can lead to lost revenue, frustrated teams, and unpaid clinical work.

The truth is: buildups and crowns are two distinct procedures, but many insurance companies bundle them unless the documentation is rock-solid.

So how do you get paid for both? Let’s break down the codes, the clinical justification, and the steps you need to take to prevent denials and ensure your buildups are reimbursed.

The Codes: Crown vs. Buildup

• D2950 – Core buildup, including any pins when required

  Used to rebuild the internal structure of the tooth when enough tooth structure is missing to support a crown.

• D2740 (or other crown codes) – Crown – porcelain/ceramic substrate

  Used to restore full function and esthetics after a tooth has been damaged or structurally compromised.

Key distinction: The buildup is to create retention for the crown. It is not part of the crown prep.

Why Buildup Claims Get Denied

Most commonly, insurers deny the buildup with a note like:

“Considered inclusive of the crown” or
“Not separately reimbursable—bundled benefit.”

This often happens because:

• The insurance plan assumes the tooth had sufficient structure,

• The documentation wasn’t detailed enough,

• Or the buildup was billed without justification that meets their policy guidelines.

How to Get Buildups Paid Separately

Here are the best practices to improve your odds of reimbursement:

1. Document, Document, Document

Insurance reviewers need proof that the buildup was medically necessary and separate from the crown prep.

Include in your clinical notes:

• That the tooth was severely broken down or had insufficient remaining structure,

• That the buildup was placed before the crown prep to retain the final restoration,

• Specific details like: “Less than 50% of coronal tooth structure remained.”

Bonus: Include intraoral photos or pre-op X-rays showing the lack of structure.

2. Use Correct Sequence of Billing

Always submit the buildup (D2950) separately from the crown and ideally on the same claim, but not bundled under one procedure.

Pro tip:
Avoid phrases like "buildup done as part of crown" in your notes. That confirms the insurer’s argument that the procedures are linked.

Instead say:

“Core buildup performed to replace missing tooth structure for proper retention of the crown restoration. Tooth had less than 2 opposing walls remaining.”

3. Preauthorize When Possible

Not every office preauthorizes crowns and buildups—but if you’re dealing with a plan known for bundling, it may be worth it.

Include:

• Clinical photos or radiographs,

• A narrative clearly stating the functional necessity of the buildup,

• Any supporting documentation showing the tooth couldn’t support a crown without reinforcement.

4. Appeal Smartly When Denied

If your buildup is denied, don’t give up. Appeal with:

• A written explanation reiterating that the buildup was not part of the prep but rather a separate, necessary step,

• Radiographic or photographic evidence,

• The ADA CDT descriptor for D2950, which clearly states it is “to replace missing tooth structure” and is separate from crown prep.

5. Know the Plan Policies

Some PPOs will only cover buildups under certain conditions:

• The tooth must be endodontically treated,

• There must be documentation of extensive damage,

• Or a minimum percentage of missing tooth structure.

Tip: Create a cheat sheet for your team showing which plans frequently deny D2950 and what documentation each one prefers.

Bonus: Protect Yourself in Fee-for-Service or Out-of-Network Scenarios

Even when patients are out of network or underinsured, you should still code and charge for D2950 when clinically appropriate.

Explain to the patient:

“Before we place your crown, we need to rebuild the tooth so it has the strength and shape to hold the crown securely. This is called a core buildup and is separate from the crown itself.”

This helps reduce confusion and supports collections, even when insurance doesn’t contribute.

Final Thoughts: If You Do the Work, Get Paid for It

A core buildup is not a luxury—it’s a necessary procedure when a tooth can’t support a crown on its own. The key to getting it reimbursed is in your documentation, language, and coding practices.

By proactively justifying the need, avoiding “bundle bait” language, and following up on denials with solid appeals, you’ll dramatically improve your chances of getting paid for both the crown and the buildup.