By someone who’s tired of watching good dentistry go unpaid

Imagine building a house on top of sand. No concrete slab, no footings—just wishful thinking and a prayer. Would anyone call that good construction?

Of course not.

So why do insurance companies think it’s acceptable to deny buildups and only pay for the crown?

Welcome to the maddening world of crown and buildup claim submissions—where insurers make up the rules, change definitions behind your back, and expect dentists to just figure it out. Let’s break this insanity down and, more importantly, talk strategy so you’re not stuck doing free work.

Crown and Buildup: The Dynamic Duo

According to Current Dental Terminology (CDT), provided and copyrighted by the American Dental Association, the codes for buildups (typically D2950 for core buildup, including pins if needed) and crowns (e.g., D2740 for porcelain/ceramic) are distinct. The CDT code definitions are not suggestions—they’re contractual language leased to insurance plans with the stipulation that definitions cannot be altered.

But here’s the punchline: they get altered anyway.

Plans like Cigna, among others, have a nasty habit of bundling the buildup with the crown, denying the buildup fee unless—and this is the magic trick—you call them and report the crown seat date.

That’s right. They’ll pay you... if you say please.

Why the Denial Game Happens

Let’s be honest: Insurance companies are in the business of denying claims, not paying them. Here's what they rely on:

• Confusion around CDT definitions

• Lack of awareness about internal policy and procedure manuals

• Delayed or missing documentation from dental teams

• Silence from providers who don’t appeal denials

If you’ve ever called an insurance rep who says, “We don’t allow separate reimbursement for buildups because we consider it part of the crown,” they’ve just violated the CDT license agreement.

And no, they won’t tell you that.

Hidden Policy Manuals: The Insurance Industry’s Worst-Kept Secret

Every insurance company has a processing policy manual—a detailed guide outlining how claims are evaluated, what documentation is needed, and which loopholes they’ve written for themselves.

These documents exist, but good luck getting your hands on them. They’re not shared publicly. They’re rarely even mentioned.

That’s like being told you’re playing Monopoly, only to find out halfway through the banker’s been using a different rulebook the whole time.

Pro Tip: When you’re stonewalled on a denial, ask for a written policy reference or a link to the carrier’s processing manual. If they refuse, document the conversation and consider filing a complaint with your state insurance commissioner.

How to Get Buildups Paid—Every. Single. Time.

Let’s get practical. If you want to make sure you’re reimbursed for a medically necessary buildup, here are the key tips that actually work:

1. Use Precise Language in Your Clinical Notes

Include:

• Pre-op and post-op photos

• Description of missing or undermined tooth structure

• Statement: “Buildup required for proper crown retention due to extensive loss of tooth structure.”

That last sentence is gold. Use it verbatim.

2. Attach Pre-Op Radiographs and Intraoral Photos

Yes, every time. You want visual proof that the remaining tooth structure can’t support a crown without a buildup.

Insurance reviewers aren't dentists—they’re adjusters following a script. Help them see the necessity.

3. Submit the Buildup on the Same Claim as the Crown, But…

• Use separate lines: Don’t just bundle them yourself.

• Include the narrative and documentation as described above.

• If the claim gets denied, call the carrier and provide the crown seat date. Yes, it’s ridiculous—but with plans like Cigna, it works.

4. Appeal Every Denial with Confidence

When a plan denies your buildup claim:

• Reference the CDT definition of D2950

• Include your original documentation

• Ask for a written explanation of why it was denied, citing plan policy

• Keep records—paper trails are your ally in future audits

5. Train Your Admin Team Like Insurance Ninjas

Your front office team needs to know:

• Which plans require seat dates (Cigna, we’re looking at you)

• What narratives to include

• How to follow up post-claim submission

• How to appeal effectively

They’re not just administrators—they’re your first line of financial defense.

6. Don’t Let Insurance Bully You into Skipping Necessary Care

If you’re tempted to stop billing buildups because “insurance never pays anyway,” remember this: you’re not just eating the cost—you’re validating their behavior.

Submit every necessary procedure. Document every denial. Appeal every injustice. Every time you push back, you make the system a little more accountable.

Final Thought: You’re a Dentist, Not a Magician

A crown without a buildup is like a hat on a ghost. There’s nothing solid underneath.

It’s time to stop letting insurance companies dictate your treatment plans, deny you fair pay, and pretend their internal playbooks are gospel.

By documenting properly, submitting confidently, and appealing persistently, you can reclaim what’s rightfully yours—and ensure your practice stays profitable without compromising care.

Quick Recap: Your Buildup Battle Plan

• Buildups and crowns are separately billable. Period.

• Insurance companies cannot legally change CDT code definitions.

• Always submit supporting photos, x-rays, and clear narratives.

• Call to report seat dates when required.

• Appeal every denial—and document everything.

• Train your team to speak insurance fluently.

Need help with appeal letters, training your admin team, or navigating these ridiculous policies? Veritas Dental Resources can help you get every dollar you’ve earned. Because great dentistry deserves great reimbursement.

Benjamin Tuinei

Founder - Veritas Dental Resources, LLC
Phone: 888-808-4513

Services:
PPO Fee Negotiators | PPO Fee Negotiating | Insurance Fee Negotiating
Insurance Credentialing | Insurance Verifications

Websites:
www.VeritasDentalResources.com | www.VerusDental.com