Let’s be honest: When you hear the word “gold” at the dentist’s office, you probably think of two things: extreme durability and an extremely high bill.

If your dentist has recommended “D2790 – Crown – Full Cast High Noble Metal,” you are looking at the “gold standard” of restorative dentistry. Unlike the porcelain crowns that chip or the base metal crowns that can cause gum allergies, a D2790 crown is built to survive decades of heavy chewing.

But here is the catch: It is expensive. And because it involves precious metals like gold and platinum, insurance companies love to play games with the coverage.

You might be asking: Why is this code so much more expensive than others? Will my insurance pay for gold, or will they “downgrade” me? How can I afford this if I have a waiting period?

This guide is your financial playbook. We aren’t just going to define the code; we are going to expose the “Least Expensive Alternative Treatment” clauses insurers use to underpay, show you how to check fair market prices, and help you find a plan that actually covers this major investment.

Decoding D2790: What Are You Actually Buying?

To understand the price tag, you have to understand the chemistry. CDT Code D2790 isn’t just a “metal crown.” It is a specific classification of alloy defined by the American Dental Association.

• “Full Cast”: This means the crown is made entirely of metal. There is no porcelain layered on top to chip off. It is solid, smooth, and incredibly kind to the opposing teeth.
• “High Noble”: This is the money word. To qualify as D2790, the metal alloy must contain at least 60% precious metal (Gold, Platinum, Palladium), and at least 40% of that must be pure Gold.

Why choose D2790? It fits better than almost anything else. Gold is malleable, meaning the dentist can burnish (rub) the edges to create a microscopic seal against your tooth, preventing bacteria from sneaking back in. It won’t crack, and unlike “Base Metal” (D2791), it rarely causes allergic reactions or turns your gums green.

The Procedure: What to Expect

Getting a D2790 crown is a two-step process, similar to other crowns, but often requires less drilling.

1. Preparation (The “Easy” Prep): Because gold is strong even when thin, the dentist doesn’t have to drill away as much of your healthy tooth as they would for a porcelain crown. You get to keep more of your natural structure.
2. Impression: The dentist takes a mold (or digital scan) of your tooth.
3. The Lab: A skilled technician casts the crown using molten high-noble alloy. This material cost fluctuates with the daily market price of gold.
4. Cementation: Two weeks later, the dentist cements the gold crown. Because of gold’s properties, the fit is usually seamless.

The Financial Reality: Costs, Traps, and Secrets

This is where the “High Noble” classification hits your wallet. Because gold prices are high, D2790 is often the most expensive crown option.

1. Estimated Costs: Cash vs. Insurance

If you have no insurance, the national average for a D2790 crown in 2026 typically ranges between $1,200 and $1,800 per tooth.

• The Gold Factor: A significant portion of this fee is the lab bill for the actual gold.
• Local Prices: Don’t guess. Use the Delta Dental Cost Estimator tool. By entering your ZIP code, you can see the “fair market value” for crowns in your neighborhood. This protects you from being overcharged.

2. The “Downgrade” Clause (LEAT)

Here is the secret insurers won’t tell you: Many dental plans have a “Least Expensive Alternative Treatment” (LEAT) clause.

• The Trap: You get a D2790 Gold Crown ($1,500).
• The Insurance Math: The insurer says, “We only pay for Base Metal crowns (D2791) on back teeth.” They allow $800 for the cheaper crown and pay 50% of that ($400).
• The Result: You owe your deductible, your 50% copay, PLUS the full difference in cost between the gold and base metal. This can leave you paying $1,000+ out of pocket.
• Patient Tip: Ask your dentist to submit a “Pre-Treatment Estimate” to see if your plan downgrades High Noble metal.

3. The “Waiting Period” Hurdle

Crowns are a “Major Service” (Class C). If you buy a standard dental policy today because your tooth broke yesterday, you will likely hit a wall.

• The Standard: Most plans mandate a 12-month waiting period for crowns,.
• The Solution: You need a plan designed for immediate need.
  • Spirit Dental: They are a market leader in offering No Waiting Periods for major services. According to their policy details, you can enroll and be eligible for coverage on major procedures like crowns effectively the next day,.
  • Humana: Look for plans like Loyalty Plus. While coverage percentages start lower (e.g., 20% for major services in Year 1), there are often no waiting periods, giving you at least some financial help immediately.

4. Annual Maximums: The Ceiling

A single D2790 crown can wipe out a standard $1,000 annual maximum.

• The Problem: If the crown costs $1,500 and your insurance covers $750, you have used 75% of your yearly allowance on one tooth.
• The Strategy: Switch to high-limit plans.
  • Spirit Dental: Offers plans where the annual maximum increases to $5,000 by the third year.
  • Cigna: The Cigna Dental 3000/100 plan offers up to $3,000 in annual benefits, giving you room to treat more than one tooth.

Financing Options: When You Can’t Pay Upfront

If you want the quality of gold but lack the cash, you have options.

1. Dental Savings Plans (The “Loophole”)

If you are facing a downgrade clause or a waiting period:

• What they are: Membership clubs where you pay a yearly fee for access to network rates.
• The Win: You can save 10% to 60% on restorative care. Since it’s a discount, the “downgrade” rules don’t apply—you get a discount off the actual D2790 price, not a substitute code.

2. Third-Party Financing

• CareCredit: The standard for dental loans. Most offices accept it for 6-12 month interest-free terms.
• Bad Credit: If you don’t qualify for traditional credit, ask about in-house payment plans. Since crowns require two visits (prep and seat), many dentists will let you split the payment: half on the first visit, half on the delivery date.

Recovery and Aftercare

Recovery from a D2790 prep is standard.

• Sensitivity: You may feel cold sensitivity while wearing the temporary crown. This is normal.
• The “Gold” Feel: Once the permanent gold crown is cemented, it often feels smoother and more natural to the tongue than porcelain.
• Longevity: A D2790 crown is an investment. With good hygiene, these crowns can last 20 to 40 years—often outliving the patient.

Frequently Asked Questions (FAQ)

1. Is D2790 better than a porcelain crown (D2740)? For back teeth, functionally, yes. Gold requires less drilling of your natural tooth and will never chip or break. Porcelain looks better (white), but gold lasts longer. If the tooth is in the back where no one sees it, D2790 is often the best clinical choice.

2. Why did my insurance pay so little for my gold crown? You likely faced a “Downgrade.” Insurance often pays the rate for a “Base Metal” (D2791) or “Porcelain-Fused-to-Metal” crown, forcing you to pay the extra cost for the high noble gold content.

3. Can I get a D2790 crown with no waiting period? Yes, but you must choose the right insurer. Spirit Dental and specific Humana plans offer no waiting periods for major services,. Standard plans will make you wait 6-12 months.

4. Does the price of gold affect my dental bill? Yes. Labs charge dentists based on the weight of the gold used and the current market price. If gold prices spike, the cost of a D2790 crown rises.

5. Is D2790 safe for MRI scans? Yes. High noble gold alloys are non-magnetic and generally safe for MRIs, unlike some base metal alloys (D2791) which can contain nickel or cobalt.

6. What is the difference between D2790 and D2791?

• D2790 (High Noble): 60%+ precious metal (Gold/Platinum). Expensive, biocompatible, yellow color.
• D2791 (Base Metal): Less than 25% precious metal. Cheap, harder, “silver” color, higher risk of gum allergy.

7. Can I resell my old gold crown? Actually, yes. If a D2790 crown is removed (extracted), you can keep it. Scrap gold buyers will pay for the high gold content, though it won’t be anywhere near what you paid for the procedure.

8. Is D2790 a “Major” service? Yes. It is classified as Class C (Major Restorative). Most insurance plans cover this at 50% after the deductible is met.

9. Can I get a gold crown if I have a metal allergy? D2790 is the safest metal option. High noble gold is “bio-inert,” meaning the body rarely reacts to it. If you have a nickel allergy, you must avoid D2791 (Base Metal) and stick to D2790 or Ceramic.

10. How much is the deductible for a crown? Typically $50 to $100. However, Cigna offers plans with deductibles as low as $0-$50, which can help lower your upfront cost.

Conclusion: The Gold Standard is Worth the Strategy

Seeing D2790 on your treatment plan means your dentist wants the longest-lasting, most conservative option for your tooth. While the upfront cost is higher than other materials, the longevity of gold makes it the cheapest option over 20 years—if you can get past the initial bill.

To protect your wallet, check your insurance for “downgrade clauses,” use the Delta Dental Cost Estimator to verify the fee, and if you are uninsured, consider Spirit Dental to skip the waiting period or a Dental Savings Plan to get an immediate discount.

Gold might be expensive, but replacing a failed cheap crown is even more expensive. D2790 is a “one and done” solution for many patients.

Disclaimer: This article is for informational purposes only and does not constitute medical or financial advice. We are not dentists or insurance agents. Dental codes and insurance benefits vary by year, state, and provider. Always verify coverage with your insurance carrier and consult a licensed professional for treatment.