Appeal letter: core buildup bundled with crown

An appeal letter template for a core buildup (D2950) the plan denied as part of the crown, with the X-ray and notes to send.

Updated November 11, 2026

The denial

The plan denied the buildup as included in the crown fee, or as filler to make the crown preparation smoother.

Why plans deny it

Plans pay a buildup only when it's needed to hold the crown on, not to fill small gaps or undercuts.
The X-ray didn't show how much tooth was missing.
No narrative said why the crown couldn't stay on without it.

Is it worth appealing?

Worth appealing when so much tooth was lost that the crown would have nothing to grip without the buildup. If the buildup only filled small gaps, plans treat it as part of the crown.

What to send with the letter

X-ray of the tooth from before treatment, showing the size of the decay or old filling
Intraoral photo after the old filling and decay were removed, if you have one
Clinical notes stating how much of the tooth was left
A copy of the explanation of benefits

The letter

Paste it into your own letterhead and fill in the [brackets]. This page has no fields: nothing about the patient is typed here.

[Office name] [Office address] [Office phone] | [Office email] [Date] [Insurer name], Appeals [Insurer appeals address or fax] Re: Appeal of claim [claim number] Patient: [patient name] | Member ID: [member ID] | Date of birth: [date of birth] Subscriber: [subscriber name] | Group: [group number] Date of service: [date of service] | Procedure: [code] core buildup, tooth [tooth number] Dear Appeals Reviewer, We are writing to appeal the decision on the claim above, on behalf of our patient [patient name]. The plan denied this buildup as part of the crown. After removing [decay / the old filling / the broken cusps], about [percent] of the crown of tooth [tooth number] was left. [Number] walls were missing. Without the buildup, the crown would have had too little tooth to hold on to. The buildup was placed to retain the crown, not to fill undercuts or smooth the preparation. The enclosed X-ray and notes show the tooth before treatment. Please review the enclosed records and reprocess the claim for payment under the patient's benefits. If you need anything else, call [contact name] at [phone]. Sincerely, [Dentist name], [DDS or DMD] NPI [NPI number] Enclosures: X-ray, photo, clinical notes, explanation of benefits

Before you send it

Send it before the deadline. The denial notice has to say how long you have and how to appeal. Employer plans that follow federal benefit claim rules give at least 180 days.
Send it to the appeals address or fax on the explanation of benefits, not the claims address.
The patient, or someone they authorize, has the right to appeal. Offices often send it for the patient; some insurers first ask for the patient's signed authorization form.
Keep a copy of everything you send and the date you sent it. If the appeal is denied, the plan has to explain why in writing.

For how plans pay this service and what to check before treatment, read the crowns billing guide.

A starting point, not legal advice. The plan's documents and the insurer decide what's paid.

CDT is a registered trademark of the American Dental Association. Tabruns is not affiliated with or endorsed by the ADA. The descriptions here are our own plain-English summaries, not the ADA's official wording; use your current CDT manual or practice software for the official code set.

Sources

Read November 11, 2026. Where a source describes one insurer's plans, we say so.

Get the patient's share in dollars, from the benefits page

Most of these denials can be seen coming from the benefits page. Tabruns reads the coverage, deductible, yearly maximum, waiting periods and frequency limits from the insurer's portal and works out what the patient owes. Patient details stay on the office computer.

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