# Does Principal downgrade fillings?

> Occasionally. As of September 2026, 11.2% of paid posterior composites (D2391–D2394) on Principal plans were paid at the amalgam fee — 19 of 169 lines across 12 practices — and 10.2% of crowns were downgraded. 16.7% of Principal's downgrades carried no remark. Small sample: 226 eligible lines and 30 downgrades in total.

_Updated 2026-09-08. Canonical: https://www.kaylie.ai/blog/does-principal-downgrade-fillings_

Principal downgrades about one posterior composite in nine — 11.2% of paid posterior
composite lines as of September 2026 — and about one crown in ten, 10.2%. Both are low
rates by the standards of this cluster, and both rest on small samples: 226 eligible paid
lines in total and 30 downgrades. The number worth carrying is the silent share, 16.7%:
five of Principal's 30 downgrades carried no downgrade remark. Principal is also the one
carrier here that describes the decision as a person's, made on the documentation you sent
with the claim.

## What we measured

| Principal | Paid lines | Practices | Stated on the remittance | Silent | Downgraded |
|---|---|---|---|---|---|
| Posterior composite (D2391–D2394) | 169 | 12 | 14 | 5 | **11.2%** |
| Crown | 49 | 8 | 5 | 0 | 10.2% |

A line is one procedure on one claim; these are paid explanation-of-benefits lines pooled
across the practices Kaylie serves, measured on 8 September 2026. Across every
downgrade-eligible code, Principal downgraded 30 of 226 paid lines (13.3%), stated 25 and
left 5 silent — the remittance carried no downgrade remark, but the allowed amount was below
the contracted fee for the billed code, or a substitute line was issued.

**Say the sample size out loud when you use these figures.** Twenty-five stated downgrades
is the minimum at which a silent share can be compared with other carriers at all, and every
Principal cell here is built from fewer than 200 lines. The direction — Principal downgrades
seldom, and when it does it does not always say so — is solid. The decimals are not.

## What Principal's own policy says

Principal's clinical guidelines state the rule and, unusually, name the decision-maker:

> "There are times when more than one procedure could correct a dental condition. In these
> cases, benefits are allowed for the least expensive procedure that will provide
> professionally acceptable results. This determination is made by a licensed Dental
> Consultant based on the documentation submitted with the claim."

— [*Principal Dental Clinical Guidelines*](https://secure02.principal.com/publicvsupply/GetFile?fm=GP62410&ty=VOP&EXT=.VOP), GP62410 (undated)

That last sentence changes what an office can do about it. Where a downgrade is an automatic
code substitution written into the plan, there is nothing to send. Where a licensed
consultant decides on the documentation submitted, the radiographs, the periodontal charting
and the narrative are the lever — and they have to arrive with the claim, not after the
decision.

Principal's DHMO schedule states the same rule as an "optional treatment" clause: "If (1) a
less expensive alternative procedure, service or course of treatment can be performed in
place of the proposed treatment to correct a dental condition, as determined by the Plan;
and (2) the alternate treatment will produce a professionally satisfactory result; then the
maximum eligible dental expense to be considered for payment will be the less expensive
treatment." (*Principal DHMO Member Copayment Schedule — California Dental Network Plan
460*, undated.) The same document applies it to bridgework: "Fixed bridgework will be covered only
when a partial cannot satisfactorily restore the case."

Neither document names posterior composites, amalgam, or a tooth scope. Principal publishes
the mechanism; the plan supplies the specifics.

## Why it depends on the plan group

"As determined by the Plan" is doing the work in Principal's own sentence. Measured across
3,790 employer groups in August 2026, whether a plan downgrades posterior composites is
settled within the group 97.7% of the time against 77.0% at carrier level. At Principal's
low base rate that means most groups never produce a downgrade at all, and the handful that
do will keep producing them — so one settled claim per group is worth more than the carrier
rate.

## What to do

- **Send the documentation with the claim, not after it.** Principal states that a licensed
  dental consultant decides on what was submitted; a narrative and radiographs that arrive
  with the claim are the only ones that can prevent the substitution.
- **Compare the allowed amount to your contracted fee for the code you billed.** One
  Principal downgrade in six carries no remark, which on this sample is five lines — small,
  but invisible to anyone reading remarks alone.
- **Record the answer against the employer group number** rather than the carrier, and note
  whether the plan is the PPO or the DHMO product, which use different mechanics.
- **Quote the patient the difference between the two allowed amounts** before treatment
  where the plan is known to downgrade.
- **Re-check this carrier before relying on it.** With 30 downgrades in the window, a
  Principal rate can move materially on a few dozen more claims.

Numbers last refreshed September 2026.