Diagnosis: Tooth Decay.
Treatment: D2740 - crown-porcelain/ceramic, D2950- core buildup, including any pins when required, tooth #2.

The insurer denied the D2740 - crown-porcelain/ceramic, D2950- core buildup, including any pins when required, tooth #2. The denial is upheld.

The patient is a male requesting benefits for crown and build up for tooth #2.

No, the D2740 - crown-porcelain/ceramic, D2950 - core buildup, including any pins when required, tooth #2, was not medically necessary.

With the documentation provided (i.e., pre-op x-rays), tooth #2 has decay on the mesial surface and an existing shallow occlusal composite restoration. The treatment needed, based upon the x-rays, is a two-surface (mesio-occlusal) restoration, not a crown. The documentation does not support the need for a crown.