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Being told you need a dental crown often raises one immediate question: will insurance help pay for it? Dental insurance can be confusing, especially when it comes to crowns, which are usually classified as a major dental procedure.
How Dental Insurance Typically Covers Crowns
In most cases, dental insurance does cover dental crowns, though coverage is typically partial. Crowns are generally classified as a major restorative dental procedure, which means insurance often helps with the cost, but patients are still responsible for a portion of the fee.
Coverage varies by dental plan, but many plans pay around 50% of the cost of a crown once requirements are met. The exact amount depends on your dental benefits, annual maximum, and whether the crown is considered medically necessary.
Why Dental Insurance Usually Only Partially Covers Crowns
Dental insurance focuses on preventive care first, then basic services, and finally major procedures. Cleanings, exams, and X-rays are often covered at a higher percentage because they help prevent bigger problems.
Crowns fall into the major restorative category because they are more complex dental procedures. They require custom fabrication, multiple steps, and long-term durability. Because of this, dental insurance policies typically share the cost with the patient rather than covering it in full.
What Affects Dental Crown Coverage
Dental insurance coverage for crowns is based on function rather than appearance. Crowns needed to restore strength, protect a weakened tooth, or repair damage are more likely to receive coverage than crowns placed for cosmetic reasons alone.
Coverage decisions are typically tied to medical necessity and supporting documentation rather than the aesthetic outcome.
Common Insurance Limits for Crowns
Even when crowns are covered, most dental plans include limitations that affect out-of-pocket costs.
Common restrictions include:
- Waiting periods: Many plans require patients to wait 6–12 months before major dental procedures, like crowns, are covered.
- Annual maximums: Insurance will only pay up to a set dollar amount per year. Once that maximum is reached, remaining costs are the patient’s responsibility.
- Frequency limits: Some plans only cover a crown on the same tooth once every several years.
- Downgrades: Insurance may reimburse based on a less expensive crown material, even if a different option is recommended.
Understanding these limits ahead of time helps prevent unexpected expenses.
What Patients Typically Pay After Insurance
Because crowns are only partially covered, patients are usually responsible for the uncovered percentage of the procedure, any amount that exceeds their annual maximum, and costs affected by waiting periods or exclusions.
Reviewing your benefits before treatment can help clarify your financial responsibility and prevent surprises.
Planning for the Cost of a Dental Crown
Dental insurance often helps offset the cost of a crown, but coverage varies by plan. Our team can help you review your benefits, explain what is covered, and outline expected out-of-pocket costs so you can plan for treatment with clarity.
To schedule an appointment at our dental office in Buffalo Grove, IL, call (847) 215-1511 or visit us at 195 N. Arlington Heights Rd., Suite 160, Buffalo Grove, IL.
FAQs
Dental insurance typically covers crown materials that restore function and durability rather than aesthetics. Many plans base coverage on a standard metal or porcelain-fused-to-metal crown, even if a different material is selected. If a more aesthetic or premium material is chosen, insurance may still reimburse at the standard rate, with the difference paid by the patient.
If the remaining balance after insurance is difficult to manage, financing options may be available. Patients can apply for financing through The Lending Club or use other credit-based payment options. Our team can review these options and help explain next steps before treatment begins.
Dentists submit standardized dental procedure codes, called CDT codes, when billing insurance for a crown. Insurance companies then apply their own allowed or contracted rate based on the patient’s plan and provider status. The insurance payment is determined by the plan, not the dentist’s fee, and any remaining balance reflects coverage limits.
