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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


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.


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

Administrative guidelines

Process to contract benefits.


CDT - D2000-D2999 - see above


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