D2790 is the CDT code for a full cast crown made entirely of high noble metal — a full-coverage, all-metal restoration (often a gold crown) with no porcelain. It's distinguished from porcelain-fused-to-metal crowns by having no ceramic surface, and from other full cast crowns by its alloy content.
Informational only — confirm the official CDT descriptor and your payers' rules independently. This is general guidance, not billing, coding, or clinical advice.
When to Use the D2790 Code
Report D2790 when a tooth is restored with a full cast crown of high noble metal — by the CDT/ADA definition, an alloy containing at least 60% noble metal with at least 40% gold. All-metal crowns are often chosen for posterior teeth where strength and a thin, kind-to-the-opposing-tooth occlusal surface matter more than tooth-colored esthetics — for example a second molar with heavy occlusal wear or limited clearance.
Pick the full cast code by alloy content:
- D2790 — full cast high noble metal (this code).
- D2792 — full cast noble metal.
- D2791 — full cast predominantly base metal.
Don't confuse D2790 with a PFM crown (D2750), which has a porcelain surface over metal, or an all-ceramic crown (D2740), which has no metal at all. Code by what was actually delivered, since plans reimburse crown types differently.
Documentation & Clinical Scenarios
Crowns are a frequently reviewed benefit, so documentation should clearly justify full coverage:
- Tooth number and the reason a crown — not a filling — is needed (extent of decay or fracture, prior root canal, cusp involvement, failing large restoration).
- Pre-operative radiograph(s) and often intraoral photos of the tooth.
- A narrative explaining why the tooth is restorable, why full coverage is necessary, and — where helpful — why an all-metal crown was selected.
- Dates — preparation and seat/delivery dates, since many payers tie the benefit to the seat date.
Record the alloy so the code reflects the high noble substructure. Keep supporting evidence in the chart even when pre-authorization isn't required, in case of a post-payment review.
Insurance & Billing Tips
- Pre-authorize when in doubt. Many plans recommend or require a pre-estimate for crowns, with radiographs and photos attached.
- Expect possible down-coding. Some plans apply an alternate benefit, reimbursing any crown at the rate of a base-metal crown, so the high-noble gold in D2790 may leave a larger patient portion.
- Check frequency and waiting periods. Crowns commonly carry a replacement frequency limit (every 5–7 years per tooth) and may have a waiting period on new plans.
- Confirm the benefit date rule. Whether the plan pays on the prep date or the seat date affects claims that span a benefit-year boundary.
- Bill buildups separately. A core buildup (D2950) or post-and-core is its own procedure when clinically necessary.
Example Case
A 63-year-old patient with heavy grinding fractures a lower second molar that has limited occlusal clearance. The dentist recommends a full cast high noble (gold) crown for durability and a gentle bite surface, and the patient accepts. The office verifies benefits, learns the plan pays crowns on a 5-year frequency at a base-metal alternate benefit, and submits a pre-estimate with a radiograph. The crown is prepped and later seated, and the claim is filed as D2790 with the seat date and alloy noted. Because benefits were verified, the patient's estimate already reflected the alloy difference.
Patients call about "getting a crown" or "a gold crown that came off" — not D2790. DentalReception AI answers those calls 24/7, books the prep or repair visit live into your schedule, and captures insurance details for clean intake, while coverage questions route to your team. See how it handles crown calls and lost crown calls, or book a demo.
Frequently Asked Questions
What's the difference between D2790 and a PFM crown like D2750?
D2790 is a full cast, all-metal crown with no porcelain, while D2750 is a porcelain-fused-to-metal crown with a tooth-colored ceramic surface over a metal core. They serve different needs: all-metal crowns are valued for strength and a thin, gentle occlusal surface on back teeth, while PFM and all-ceramic crowns offer esthetics. Code by the restoration actually delivered, and document the alloy so the high noble content is on record.
Does D2790 include the core buildup or post?
No. A core buildup (D2950) or a post-and-core is a separate procedure with its own code when clinically necessary to support the crown. Document and bill it separately, with its own justification, rather than rolling it into the crown fee. Bundling a needed buildup into the crown understates the work, while billing an unnecessary one is an audit risk.
Will insurance pay the full high-noble (gold) rate?
Not always. Many plans apply an alternate benefit, reimbursing any crown at the rate of a base-metal crown, so the gold content in a D2790 crown may leave a larger patient portion. Because high noble alloy also carries a higher lab cost, verifying benefits before treatment is especially important here — it lets you give the patient an accurate estimate and explain any gap between the plan's allowance and the crown placed.
Do I need a pre-authorization for a D2790 crown?
Many plans recommend or require a pre-estimate for crowns, submitted with a radiograph and often intraoral photos. Because crowns are a frequently reviewed benefit and may be down-coded by alloy, getting the pre-estimate back before the prep appointment lets you confirm frequency limits and any waiting period and quote the patient an accurate out-of-pocket amount before the tooth is prepared.
Confirm the current CDT descriptor and your specific payer policies before billing — browse the full dental code library or see our insurance verification feature.