Crown Replacement

Coverage Status: COVERED

Standard crowns are a covered benefit under Health First Colorado adult dental.

Details

Service Frequency Cost Prior Auth?
Crown 1x every 7 years per tooth $0 Yes
Recement crown Only 7+ months after placement $0 No

Important Notes

7-Year Rule

Crowns are covered once every 7 years per tooth. If your existing crown was placed less than 7 years ago, a replacement likely won't be approved unless there's documented clinical necessity (significant decay, fracture, etc.).

Second Molars

Second molars must meet additional clinical criteria for crown coverage. Your dentist will need to document the medical necessity.

Third Molars

Third molars (wisdom teeth) are NOT covered for crowns.

Prior Authorization Process

  1. Your dentist examines the tooth and determines a crown is needed
  2. They submit a prior authorization request to DentaQuest with X-rays and clinical notes
  3. DentaQuest reviews and approves/denies (typically 5-15 business days)
  4. Once approved, the crown procedure is scheduled
  5. Do NOT start treatment before authorization is confirmed

Implant-Supported Crowns

If the crown you need is on an implant stem, see Procedures/Crowns on Implant Stems — that's a different situation with different coverage rules.

See also: Coverage Summary | Your Treatment Plan | Procedures/Crowns on Implant Stems