What's a buildup, and why is it a separate charge?
The short answer
A crown needs enough tooth to hold on to. When too much is missing, your dentist first rebuilds the core of the tooth with filling material. That's a buildup, and it's its own step with its own code (D2950), so it shows up as its own line on your plan and bill.
Not every crown needs one
A tooth with plenty of structure left may need no buildup at all. Also, filling in small gaps or uneven spots while shaping the tooth is normally part of the crown, not a separate buildup.
The same goes for bridges. The teeth on either side that hold a bridge get crowns too, and when those teeth are healthy, they typically don't need a buildup.
Teeth that have had a root canal
If a root-canal-treated tooth is badly broken down, it may need a post and core instead: a small post in the root anchors the rebuilt core. See Do I need a crown after a root canal?
Will insurance pay?
Plans handle buildups differently:
- Some pay for a buildup separately when the records show enough tooth was missing.
- Some count it as part of the crown and pay one benefit for both.
- Some don't pay for buildups at all.
When a plan reviews a buildup, it looks for how much tooth was lost, using your X-rays and sometimes photos. An X-ray doesn't always show how much of the tooth is missing, so a photo taken before the buildup can help. If the plan decides the tooth didn't need one, it may pay only for the crown. See My treatment didn't meet the plan's criteria.
If your dentist is in network and the plan doesn't pay for the buildup, whether you can be billed for it depends on your plan and the reason. Your Explanation of Benefits shows whether that amount is yours to pay.
Questions to ask
- Why does this tooth need a buildup?
- How much of the tooth is missing?
- Will you include the buildup in the predetermination?
- If my plan doesn't pay for the buildup, what will I owe?
- Before we schedule, can I get my cost in writing? (A predetermination if I'm using insurance, or a good faith estimate if I'm paying myself.)
When a second opinion makes sense
Reasonable if a buildup is recommended on a tooth with only a small filling or cavity.