The average cost of a crown with delta dental insurance is approximately $450. However, there are many factors which influence your copayment, thereby making it cost more or less than that.
Factors affecting crown cost:
- Percent coverage
- Alternative benefits
- Annual maximum
- Provider network status
We will go over all of these potential factors that influence the cost of your crown with delta dental and how they influence the copay. We’ll give examples of actual insurance claims to help you understand how insurance pricing works.
Although before we do that, we should go over where we got the average baseline price of $384 for the crown from.
Average cost of crown with delta dental
The average delta dental crown cost of $450 is derived from seeing an in-network dentist with 50% coverage for an all ceramic crown. The procedure code used to bill for an all ceramic crown is D2740.
Breakdown of the cost:
- Estimated in-network fee for D2740 is $900 total.
- Most common delta dental crown coverage is 50%
Calculation: $900x 50% = $450 copayment
- Delta dental will cover half of the cost at $450.
- You will cover the other half of the cost which is also $450.
The calculation for the cost of the tooth cap is straightforward if there are no other factors involved. However there are usually at least one other factors affecting the price.
Delta dental crown coverage
Most commonly we see the delta dental crown coverage at 50% and it is considered a major procedure. The cookie cutter insurance plan from them separates procedures into basic (80% coverage) vs major (50% coverage).
Factors affecting copayment
These factors may increase or decrease the cost of your crown if you have delta dental. They are typically located in the fine print of your insurance contract so be sure to read it thoroughly.
The most common delta dental coverage for crowns is 50% but it can be higher or lower depending on your plan.
The image above is of a pre-treatment estimate for a crown for tooth #19. If you look at the column under contract benefit level, it lists the coverage as 50% which is the most common.
Coverage percentages which we’ve seen:
If you have 0% coverage then it would mean that you’d be responsible for the full cost of the crown at $900. On the contrary, the higher the coverage percentage, the less you’d need to pay out of pocket. The better the coverage your plan offers, the better your insurance is.
The current trend in dentistry is to have all ceramic crowns which is porcelain with no metal. The billing code for that is D2740 but some insurances will apply an alternative benefit of D2790, which is an all metal crown.
This alternative benefit is commonly known as a “downgrade” because the code your insurance substitutes it with has a lower fee. The implication of this is that you’re responsible for the difference in fees.
- Fee for D2740 is $900
- Fee for D2790 is $800
You will be responsible for the price difference if you choose to get an all ceramic crown instead of an all metal one.
The image above is of a processed claim from delta dental where they applied an alternative benefit of D2790. The code that was billed out as D2740 but there is a common on the side “**FLA”.
If you read the fine print it states, “We have applied an alternate procedure number and allowance for processing purposes only. Payment is based on our maximum allownace for the alternate procedure.”
Basically, delta refused to cover an all ceramic crown and will only cover an all metal crown.
Each insurance plan has an annual maximum for the amount of benefits it will pay out each year. If you have a high maximum it will cover what it says it will. Although if you have a low maximum, it may not cover what it states.
- If you have a $1000 annual maximum, the 50% coverage for an all ceramic crown will cover the $450 insurance benefit. You’ll be responsible for the other $450 copayment.
- If you have a $250 annual maximum, despite having 50% coverage for the crown, your insurance will only cover $250. Your copayment would be $900 – $250 = $650
The example above is to show you how having a low maximum can increase your copay.
Most dental insurances have an annual deductible which must be paid prior to benefits being disbursed. In other words, the deductible needs to be paid first or met before the insurance will start covering services.
The most common deductible which we see from our delta dental patients is $50. However we’ve also seen as low as $25 and as high as $100. The amount varies and depends on your insurance plan.
Therefore if you have a deductible, it will add to the cost of your crown.
Provider network status
The network status of your dentist plays a large role in the cost of your crown. Everything that we’ve discussed above only applies to a dentist that is in-network with delta dental.
If the dentist that you’re seeing is out of network, none of the above would apply. The average cost of the crown would be completely different from all of the calculations above.
The average cost of the crown would be significantly more than $450 but what it is would depend on your dentist’s private fee schedules. As a ball park figure, the average cost of a crown without insurance is $1316.05 and if delta covers $450, it would be a $866.05 copay.
Decreasing the delta dental crown cost
The only way to decrease your out of pocket costs with delta dental is by choosing a plan with higher coverage.
When you signed up for your insurance, they usually presented to you options for different plan levels. There was probably a low plan, basic plan, and premium plan. The higher the plan level, the higher the coverage would be for the procedures. Of course, the monthly premiums for the insurance would also cost more.
Basically if you wanted your delta insurance to cover more, you should switch to a higher tier plan.