You might be surprised to learn that porcelain crown replacement covered by Delta Dental can cut your out-of-pocket costs by hundreds of dollars. Porcelain crowns are a key part of restorative dentistry covered by Delta Dental, so you get both function and a natural look in one go. If you’re a retiree or caregiver weighing restoration options, this benefit makes all the difference. In this article, you’ll discover how your Delta Dental plan works, what it covers, and how to keep more cash in your pocket while restoring your smile.
Here’s what we’ll cover:
- How Delta Dental defines covered crowns
- What you can expect to pay in-network vs out
- The difference between Delta PPO and DeltaCare USA
- Why porcelain caps shine vs metal options
- Step-by-step of the crown procedure
- Tips to care for and extend your crown’s life
- Ways to maximize your coverage before you begin
Understanding your coverage
Delta Dental treats full crowns (codes D2710–D2794) as a major restorative service. That means if you need a porcelain cap to fix decay, cracks, or after a root canal, you’ll likely see coverage. But if you’re replacing a crown purely for color or shape changes, that counts as cosmetic and usually isn’t covered.
Major vs cosmetic crowns
- Full crowns replace teeth damaged by decay, fractures, or large restorations
- Cosmetic crowns only change color or shape (no functional need)
Your dentist will submit x-rays (pre-operative periapical radiographs) and possibly intra-oral photos to prove the medical necessity. If you’re unsure, ask them to request a pre-treatment estimate. You’ll get a written breakdown of what Delta Dental will pay and what you’ll cover.
Learn more about these distinctions in our guide on dental crowns covered by Delta Dental for seniors.
Frequency limits and waiting periods
Most Delta plans require a five-year interval before covering a replacement on the same tooth. That helps limit premature swaps. If it’s been five years or more since your last crown, you’re good to go. Note that DeltaCare USA plans may have shorter waits, so always double-check your policy details.
Estimating crown costs
Out-of-network porcelain crowns can range from $1,100 to $2,000 per tooth. In-network dentists agree to lower fees, which means you pay less up front. To give you a clearer picture, here’s a quick comparison:
| Crown type | In-network cost (approx) | Out-of-network cost |
|---|---|---|
| Porcelain crown on molar | $900 – $1,200 | $1,300 – $2,000 |
| Porcelain-fused-to-metal (PFM) crown | $800 – $1,100 | $1,200 – $1,800 |
| Temporary crown (included in prep fee) | Often no extra charge | $100 – $200 |
After seeing those fees, remember you’ll pay only your share. With a Delta PPO plan, that’s typically 50% of the crown cost after you meet your deductible.
Using HSA and FSA
If you’ve got a high-deductible health plan, you can stash money in a Health Savings Account (HSA). Your contributions are pre-tax, and you can use them on crowns and other dental work. A Flexible Spending Account (FSA) offers similar savings but usually has a “use it or lose it” rule by year-end. Check your account balance before scheduling your treatment.
Comparing plan options
Delta Dental offers two main plans that cover crowns: the PPO plan and DeltaCare USA. Both help you save, but in different ways. Here’s a side-by-side:
| Feature | Delta PPO | DeltaCare USA |
|---|---|---|
| Coverage level | 50% after deductible | Fixed copay (e.g., $350) |
| Annual deductible | $50 – $150 per person | None |
| Network flexibility | Any dentist, better in-network rates | Must use DeltaCare USA network |
| Waiting period (crowns) | 6 – 12 months | 3 months |
| Pre-treatment estimate | Strongly recommended | Built in |
With PPO, you pay half after meeting your deductible. If your plan has a $50 deductible and a $1,200 crown, you’d owe $600 (plus any unmet deductible). DeltaCare USA gives you a set copay so you know exactly what’s due. Which works better for your budget?
Choosing porcelain crowns
Porcelain crowns blend strength with a natural appearance. They match your tooth color, resist staining, and feel just like the real thing. Here’s what makes them a standout choice:
Benefits of porcelain
- Natural translucency mimics enamel
- Lasts 10–15 years on average (sometimes up to 30)
- Less likely to irritate gums
Porcelain vs PFM crowns
Porcelain-fused-to-metal crowns have a metal core with a porcelain overlay. They can be cheaper, but over time the metal margin may show near your gum line. If aesthetics are top of mind, pure porcelain is the way to go.
Metal alternatives
Sometimes your plan may cover a metal or PFM crown at a higher percentage than porcelain. If you see a 60% metal-crown benefit vs 50% for porcelain, ask your dentist to run numbers so you can decide if the extra cost is worth the look.
Getting the procedure done
A porcelain crown placement usually spans two visits. Your dentist will prep your tooth, take an impression, and fit a temporary cap. A lab makes your custom crown, and you return for the final fitting. Let’s break it down.
- First appointment
- Numb your tooth and surrounding area (local anesthesia)
- Remove decay, old fillings, or damaged tooth structure
- Shape the tooth for the crown
- Take an impression (digital or putty-based)
- Place a temporary crown
- Lab fabrication
- Your impression goes to a dental lab
- Technicians match shade and shape to your natural teeth
- Process typically takes 2–3 weeks
- Second appointment
- Remove the temporary crown
- Clean and prep the tooth
- Try in the final porcelain crown
- Adjust fit and bite
- Cement the crown with dental adhesive
Temporary sensitivity to hot and cold is normal for a week or two. If pain lingers beyond that, call your dentist.
Caring for your restoration
A little daily care helps your crown last for years to come. Treat it like a natural tooth.
Daily care tips
- Brush twice a day with fluoride toothpaste
- Floss gently around the crown margin
- Use an interdental brush if standard floss catches
- Rinse with a non-alcohol mouthwash if recommended
Foods to avoid
Porcelain is tough, but the cement can chip if you bite into very hard or sticky items. Skip:
- Ice cubes and hard candy
- Nuts and popcorn kernels
- Chewy sweets like caramel and toffee
When to replace
Crowns generally last 10–15 years, sometimes longer. Keep an eye out for:
- Chips or cracks in the porcelain
- Persistent sensitivity or discomfort
- Gaps or wear at the crown edge
If you spot these issues and it’s been at least five years, you may qualify for a replacement under your Delta Dental benefits.
Maximizing your benefits
Want to stretch your coverage further? Try these strategies before you book your appointment.
Request a pre-treatment estimate
Ask your dentist to send a “pre-determination” to Delta Dental. You’ll get a clear, written estimate of coverage and your out-of-pocket share—no surprises.
Explore plan upgrades
During open enrollment, consider stepping up to a tier with higher crown coverage. A small bump in premium can save you hundreds when you need a major restoration.
Consider alternative materials
If pure porcelain stretches your budget, discuss other options like a PFM cap or high-noble metal crown. You can compare coverage with other providers in our article on Aetna covered porcelain crown replacement.
Coordinate with other treatments
Pairing a crown with a root canal often qualifies for combined coverage. See how you can save under the same plan in our guide to Delta Dental covered root canal and crown.
Key takeaways and next steps
- Porcelain crown replacement covered by Delta Dental can slash your out-of-pocket costs when done for functional reasons
- Delta PPO covers 50% after deductible, while DeltaCare USA uses fixed copays for clear budgeting
- Pure porcelain crowns offer the best aesthetics, but PFM and metal alternatives may cost less out of pocket
- Always request a pre-treatment estimate, explore HSAs/FSAs, and ask about plan upgrades
- Care for your crown daily and avoid hard or sticky foods to extend its lifespan
Ready to restore your smile with confidence? Call your Delta Dental dentist, schedule a pre-determination, and enjoy a more predictable, budget-friendly porcelain crown replacement.
