# Which dental insurers downgrade crowns?

> Rates run from zero to 46.2%. As of September 2026, on paid crown lines: Guardian 46.2%, MetLife 45.3%, Cigna 28.0%, Aetna 18.6%, Delta Dental 8.5%, UnitedHealthcare 0.3%. The substitute is a cast-metal crown of a named grade — D2740 and D2750 to D2790, D2751 to D2791, D2752 to D2792 — usually on molars only.

_Updated 2026-09-08. Canonical: https://www.kaylie.ai/blog/which-dental-insurers-downgrade-crowns_

Crown downgrades are far less uniform than filling downgrades. As of September 2026 the
measured rate on paid crown lines runs from zero — Humana and United Concordia downgraded
none of the crowns we saw them pay — to 46.2% (Guardian), and the carriers are spread along
that range rather than sorted into two camps: Guardian, Ameritas and MetLife downgrade close
to half of the crowns we see them pay, Cigna at 28.0% and Aetna at 18.6% sit between, and
Delta Dental, Anthem and UnitedHealthcare downgrade fewer than one in ten, with Principal at
about one in ten. What a downgraded crown is paid as is more consistent: a cast-metal crown
of a named metal grade — D2740 and D2750 to D2790,
D2751 to D2791, D2752 to D2792 — and, on most carriers' published wording, only on molars.

## What we measured

| Carrier | Paid crown lines | Practices | Stated on the remittance | Silent | Downgraded |
|---|---|---|---|---|---|
| Guardian | 353 | 13 | 126 | 37 | **46.2%** |
| Ameritas | 68 | 10 | 26 | 5 | 45.6% |
| MetLife | 605 | 15 | 271 | 3 | **45.3%** |
| Cigna | 731 | 13 | 177 | 28 | 28.0% |
| Aetna Dental Plans | 86 | 8 | 16 | 0 | 18.6% |
| Principal | 49 | 8 | 5 | 0 | 10.2% |
| Delta Dental | 2,004 | 15 | 113 | 57 | 8.5% |
| Anthem | 56 | 7 | 0 | 1 | 1.8% |
| UnitedHealthcare | 313 | 14 | 1 | 0 | 0.3% |
| Humana | 48 | 9 | 0 | 0 | 0.0% |
| United Concordia | 55 | 9 | 0 | 0 | 0.0% |

A line is one procedure on one claim; these are paid explanation-of-benefits lines on
porcelain, ceramic and porcelain-fused-to-metal crown codes, pooled across the practices
Kaylie serves, measured on 8 September 2026. The Ameritas, Aetna, Principal, Anthem, Humana
and United Concordia rows are built on fewer than 100 lines each — directional, not precise.
"Silent" means the remittance carried no downgrade remark, but the allowed amount was below
the contracted fee for the billed code, or the carrier issued a substitute line: on crowns
that is a third of Delta's downgrades (57 of 170) and 28 of Cigna's 205.

## What the carriers' own policies say

**Three different tooth scopes.** MetLife's provider manual scopes its crown rule to molars
and names the substitute: "When porcelain fused to metal crown or any type of veneer material
is submitted on a molar tooth, MetLife may apply an alternate benefit of a full gold crown."
(*MetLife Preferred Dentist Program (PDP) Resource Manual*, undated.)

Delta's federation-wide "Optional Services" list is narrower still, and the only carrier
sentence in the cluster that distinguishes arches: "porcelain, resin or similar materials for
crowns placed on a maxillary second or third molar, or on any mandibular molar (an allowance
will be made for a porcelain fused to high noble metal crown)." ([*Delta Dental of
Pennsylvania Individual & Family PPO Preferred Plan*](https://www1.deltadentalins.com/content/dam/ddins/en/pdf/hcx/2024/dd-dd-pa-i-fam-prf-24.pdf), 2025.) The upper first molar is not in
scope. Delta Dental of Oregon draws it one tooth further forward and substitutes a different
material: "Porcelain crowns are considered cosmetic dentistry if placed on the upper second
or third molars or the lower first, second or third molars. Coverage is limited to gold
without porcelain." (*Delta Dental PPO 1000 Oregon Group Dental Plan Handbook*, 2026.)

Aetna is the broad end: "D2740 Crown - porcelain/ceramic — An alternate benefit will be
provided on **posterior teeth**", with the same flag across D2750, D2751, D2752 and the
abutment, pontic and retainer-crown families ([*Aetna Dental FEDVIP 2026 Brochure*](https://www.opm.gov/healthcare-insurance/healthcare/plan-information/plans/pdf/2026/brochures/02AP-01.pdf), OPM).

**Blue Shield of California frames it as cosmetics** rather than materials: "Full ceramic,
porcelain, ceramic-porcelain crowns are considered cosmetic procedures for anterior and
posterior teeth; reimbursement will be at the same level as the appropriate metal or
porcelain-nonprecious metal crown for the tooth." ([*Blue Shield of California HMO Benefit
Guidelines*](https://www.blueshieldca.com/content/dam/bsca/en/provider/docs/Dental-BlueShieldHMOPlansDHMO.pdf), January 2026.)

**And on a copay-schedule dental HMO there is no allowance to re-base**, so most price the
better material as a surcharge instead: "porcelain, resin or resin-based composite is used on
molar crowns, the member is responsible for an additional $75 co-payment above the set crown
co-payment" (*MetLife SafeGuard DHMO Schedule of Benefits*, undated); "an additional $125 for
the use of precious (high noble) or semi precious (noble) metal" (*United Concordia Active DHMO
Schedule of Benefits, Concordia Plus CA 21*, undated); "$150 per unit" on Blue Shield of
California's dental HMO products. Blue Shield of California is also the exception that states a
substitution outright: the HMO Benefit Guidelines quoted above re-base a ceramic crown to the
metal crown allowance, while its own dental HMO products still carry the per-unit metal charge.

One thing a downgraded crown is **not** is necessarily a cheaper crown. The named targets
include full cast high noble — gold — so the substitution is about the material the contract
will pay for, not about a smaller number.

## Why it depends on the plan group

Crown scope is a plan-level setting, and it can drop out of a plan entirely: Delta's Georgia
Basic tier carries only the composite example from the Optional Services list, while the
Preferred and Premium tiers carry the crown clause too, because a tier that sells no Major
coverage has no crown benefit to re-price. Measured across 2,748 employer groups in August
2026, the tooth-scope answer is settled within the group 97.4% of the time and at carrier
level only 77.6%.

## What to do

- **Compare the allowed amount to your contracted fee for the crown code you billed.** On
  crowns the silent share is higher than on fillings for both Delta and Cigna.
- **Write the tooth number and arch into the note, not "molar".** Upper first molars are
  outside Delta's Pennsylvania, Georgia and California wording and inside Oregon's.
- **Put the substitute code in the pre-treatment estimate** — D2790, D2791 or D2792 — so the
  patient's number is explainable when the explanation of benefits arrives.
- **Record the answer against the employer group number and the plan tier.**
- **On a dental HMO, look for a materials surcharge instead**, capped per unit, and quote
  that rather than a percentage difference.

Numbers last refreshed September 2026.