Provisional Crown

Policy No: 16A
Originally Created: 01/01/2011
Section: Restorative
Last Reviewed: 01/01/2019
Last Revised: 01/01/2018
Approved: 01/01/2018
Effective: 01/01/2018

Description

Provisional crown (D2799)
Crown utilized as an interim restoration of at least six months duration during restorative treatment to allow adequate time for healing or completion of other procedures. This includes, but is not limited to, changing vertical dimension, completing periodontal therapy or cracked tooth syndrome. This is not to be used as a temporary crown for a routine prosthetic restoration.

Policy/criteria

Procedures are in accordance with generally accepted standards of dental practice.

Administrative guidelines

Process to contract benefits.

Codes

CDT - D2000-D2999 - see above.

Disclaimer

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