D2751 Crown PFM Base Metal Template (CDT)

The template

Pick your PMS to format the placeholders, then copy.

PMS format

[Prompt:"name"]

Crown - porcelain fused to base metal.

RMH: Medical history reviewed/updates
Vitals: BP/pulse; other vitals if indicated

Tooth: #Tooth number(s)
Indication: Indication/diagnosis

Crown code support: Extent of decay/fracture and surfaces involved
Prior restoration/crown: Material/size/condition; placement date/age if replacement
Reason for crown/replacement: Full-coverage need/recurrent decay/open margin/fracture/etc.
Endodontic status/prognosis: Vital/RCT treated; symptoms/no symptoms; prognosis
Periodontal status/prognosis: Bone loss/SRP history/mobility or none; prognosis
Image labels: Diagnostic-quality radiographs/photos labeled tooth/date

Radiographs/photos: Radiographs/photos reviewed/taken and findings

Consent: Consent/PARQ reviewed; signed/verbally obtained

Anesthesia: Anesthetic used
Carps: Carpules/amount

Shade: Shade
Stump shade: Stump shade

Preparation Appointment:
Existing restoration removed.
Caries excavated.
Tooth prepared for PFM crown.
Adequate reduction verified.
Margins: Margins
Impression/scan taken.
Opposing impression taken.
Bite registration taken.
Provisional fabricated and cemented with temp cement.
Occlusion checked.
Contacts checked.

Lab:
Material: Base metal with porcelain.

Cementation Appointment:
Provisional removed.
Crown tried in.
Fit verified.
Marginal integrity verified.
Shade verified.
Contacts verified.
Occlusion verified.
Crown cemented with: Cement used
Excess cement removed.
Final occlusion check.
Final polish.

Complications: None or describe.

Patient tolerance: Tolerance/response.

Post-op instructions: Instructions reviewed.

NV: Next visit

Field glossary

What each placeholder represents.

Medical history reviewed/updates
Note that medical history was reviewed and any changes since last visit — meds, conditions, allergies, ASA status, pregnancy status. For D2751 specifically, document explicit nickel-allergy / metal-hypersensitivity screening, since most predominantly base-metal alloys are nickel-chromium-based.
BP/pulse; other vitals if indicated
Today's blood pressure and pulse. Required by many state boards on operative visits and by sedation-capable practices. Add temperature, SpO2, or weight if clinically indicated.
Tooth number(s)
Universal numbering for permanent teeth (#1–#32). One tooth per D2751 line item. Do not use D2751 on implant restorations — those use D6058–D6062.
Indication/diagnosis
Specific clinical finding that justifies full coverage — fractured cusp with crack, large failing restoration with recurrent decay, post-RCT protection, cracked-tooth syndrome with positive bite test, broken-down tooth with insufficient structure for direct restoration. Avoid generic "broken tooth."
Extent of decay/fracture and surfaces involved
The clinical narrative that defends full coverage over a direct restoration or onlay. Note depth, surfaces, cusps compromised, remaining tooth structure post-prep, and ferrule continuity.
Material/size/condition; placement date/age if replacement
If a prior restoration or crown is being replaced — material (PFM, gold, zirconia, EMax, amalgam, composite), placement date or approximate age, and current defect (open margin, recurrent decay, porcelain fracture, decementation, esthetic failure). Drives replacement-frequency analysis on the carrier side.
Full-coverage need/recurrent decay/open margin/fracture/etc.
The specific clinical reason a crown is required now — full-coverage protection, recurrent caries under failing restoration, fractured cusp, crack propagation risk, post-endodontic protection. This is the line auditors look for.
Vital/RCT treated; symptoms/no symptoms; prognosis
Endodontic status. Vital with negative percussion and normal cold response, or RCT-treated with date and current symptoms. Crowning a symptomatic tooth without endo evaluation is a recurring audit finding.
Bone loss/SRP history/mobility or none; prognosis
Periodontal status. Probing depths, bone level, mobility (Class I/II/III or none), SRP history, and supportive prognosis. Crowning a perio-hopeless tooth is a recurring audit finding.
Diagnostic-quality radiographs/photos labeled tooth/date
Confirm pre-op periapical or bitewing labeled with tooth number and date. Pre-prep, post-prep, and post-cementation IO photos materially strengthen audit defense and predetermination support.
Radiographs/photos reviewed/taken and findings
Imaging used to support diagnosis and outcome — pre-op PA showing apical status, bitewing showing recurrent caries or open margin, IO photos pre- and post-prep. One- to two-line interpretation linking the image to the clinical finding.
Consent/PARQ reviewed; signed/verbally obtained
Procedure, alternatives (no treatment, direct restoration, onlay, alternate crown materials), risks (sensitivity, future RCT need, fracture, decementation, post-op pain), nickel-content disclosure for base-metal PFM, and questions addressed. Note signed vs verbal consent.
Anesthetic used
Agent, concentration, and vasoconstrictor at the prep visit (e.g., "4% articaine 1:100k epi via IAN block + long buccal infiltration"). The cementation visit may not require anesthesia — document accordingly.
Carpules/amount
Number of carpules administered (e.g., 1.8). Tracks total dose for safety and supports separately reportable D9215 if the practice bills it.
Shade
Vita classical (e.g., A3) or Vita 3D-Master shade for the porcelain veneer. Take with hydrated tooth and natural lighting before prep.
Stump shade
Shade of the prepared dentin under the planned crown. Important for D2751 because thin facial porcelain over a dark Ni-Cr substructure can show the stump through; lab uses this to mask and place the opaquer layer.
Margins
Margin design and placement — chamfer, shoulder, or shoulder-with-bevel; supragingival, equigingival, or subgingival; retraction technique (cord, paste, laser). PFM margins are commonly chamfer or shoulder-with-bevel.
Cement used
Specific cement product and technique (RelyX Luting Plus / FujiCem / Ketac-Cem / zinc phosphate / resin cement). Include isolation method and tack-cure technique if used. Excess subgingival cement removal is audit-relevant.
None or describe
Complications during prep or cementation — "None" is acceptable when accurate. Otherwise describe (e.g., "porcelain chip on lingual at try-in; lab adjustment, re-glaze; recemented at follow-up").
Tolerance/response
Patient response across both prep and cementation visits — tolerated well, mild discomfort managed, no adverse events. Specific is better than "WNL."
Instructions reviewed
Post-op instructions covered — soft diet 24 hours after cementation, post-op sensitivity expectations, hygiene around the new crown margin, when to call. Note verbal review and whether a written handout was provided.
Next visit
Scheduled follow-up — typically a 2- to 4-week post-cementation occlusal check, integrated with the next recall (6 months for D0120 and prophy). Note any same-arch restorative work still planned.

Documentation requirements

Crown documentation has to support why full coverage was indicated — not merely that a crown was placed. The D2751-specific elements are alloy disclosure, nickel-allergy screening, and a two-visit (prep + cementation) procedural record. A defensible note includes:

Tooth number — universal numbering (#1–#32). One tooth per D2751 line item.
Indication / diagnosis — specific finding that justifies full coverage: large MOD with undermined cusp(s), fractured cusp with deep crack, recurrent caries under existing crown, post-endodontic protection of a structurally compromised tooth, cracked-tooth syndrome with positive bite test, broken-down restoration with insufficient remaining tooth structure for a direct restoration. Generic "broken tooth" is weaker than "fractured DL cusp #19 with crack extending subgingivally on the distal" supported by labeled photo.
Crown code support / full-coverage rationale — extent of decay, fracture, or existing restoration; surfaces involved; cusps compromised; remaining tooth structure post-prep; ferrule height and continuity; reason a direct restoration or onlay is not adequate. This is the line that defends against a "not medically necessary — restoration adequate" downgrade.
Replacement rationale (if applicable) — material of the prior crown (PFM, gold, zirconia, EMax, etc.), placement date or approximate age, and current defect (open margin, recurrent decay, porcelain fracture exposing metal, decementation beyond re-cementation, esthetic failure). Carriers commonly enforce a 5- to 10-year replacement-frequency window on indirect restorations; replacing inside that window without a documented clinical reason is a frequent recoupment trigger.
Endodontic status / prognosis — vital with negative percussion and normal cold response, or RCT-treated with date and current symptoms. A symptomatic, non-RCT-treated tooth crowned without endo evaluation is a recurring audit finding ("crown over an endodontically-failing tooth"). If the tooth is RCT-treated, note the date and the post-treatment status.
Periodontal status / prognosis — probing depths, bone loss, mobility, SRP history, and supportive prognosis. A mobile (Class II+) tooth crowned without a perio note is another recurring audit finding. The book is explicit: crown documentation should capture perio prognosis, not just operative findings.
Diagnostic image labels — pre-op periapical or bitewing labeled with tooth number and date; pre-prep and post-prep intraoral photos; photo of fractured cusp or open margin where applicable. Pre-op imaging plus a labeled IO photo is the strongest combination for full-coverage justification.
Nickel allergy screening — an explicit statement in RMH or the consent block. Most predominantly base-metal alloys are nickel-chromium-based; nickel hypersensitivity is the single hardest contraindication to D2751 and the one a chart should never be silent about. If nickel allergy is reported or unknown, switch to D2752 (noble), D2750 (high noble), titanium PFM (D2753), or zirconia (D2740) and document the alloy substitution. The ACP and multiple state board advisories treat undocumented nickel screening on a base-metal PFM as a chart deficiency.
Material details / alloy disclosure — name the alloy ("Vera Bond II Ni-Cr base alloy," "Argeloy N.P. base," "Co-Cr base") rather than a generic "PFM." This protects against an alloy-tier audit (carrier requests lab slip; if the slip says noble, the D2751 claim looks like an undercoded D2752 — billing in the patient's favor, but a charting defect).
Shade and stump shade — Vita classical or 3D-Master shade for the porcelain veneer; stump shade of the prepared tooth (especially for thin facial porcelain over a dark Ni-Cr substructure, where the stump can show through).
Margin design — chamfer, shoulder, or shoulder-with-bevel; supragingival, equigingival, or subgingival placement; extent of preparation. PFM margins are commonly chamfer or shoulder-with-bevel; pure shoulder is more often associated with all-ceramic preps.
Anesthesia — agent, concentration, vasoconstrictor, and number of carpules at the prep visit. The cementation visit may be done without anesthesia; document accordingly.
Prep procedure — caries excavation, existing-restoration removal, pulp-exposure status (explicitly "none" or describe), reduction confirmed (occlusal ~1.5–2 mm for PFM, axial ~1.0–1.5 mm), retraction (cord, paste, laser), impression/scan technique, opposing impression, bite registration, provisional fabrication and cementation. The body's structured prep block hits each of these.
Lab — name the lab and the alloy on the lab slip. Keep the slip with the chart in case of audit.
Cementation procedure — provisional removal, try-in (fit, marginal integrity, shade, contacts, occlusion), cement type (resin-modified glass ionomer, conventional GI, zinc phosphate, or resin cement), excess cement removal, final occlusion check, polish.
Cement used — name the product (RelyX Luting Plus, FujiCem, Ketac-Cem, Maxcem, etc.) and the technique. Excess subgingival cement is a top cause of post-cementation peri-implant or peri-radicular inflammation; documented removal is audit-relevant.
Complications — explicit "none" or describe (e.g., "porcelain chip on lingual at try-in; lab adjustment, re-glaze; recemented at follow-up").
Patient tolerance / response — tolerated well at both visits, no signs of distress.
Post-op instructions — soft diet for 24 hours after cementation, post-op sensitivity expectations, when to call, hygiene around the new crown margin.
Next visit — typically a 2- to 4-week post-cementation occlusal check or recall integration.

Common denial reasons

The most frequent reasons D2751 is denied, downgraded, or recouped:

Replacement inside frequency window without narrative — a crown on the same tooth within 60 months of a prior crown, no narrative, no image of fracture or recurrent caries. Auto-denial or auto-downgrade.
Alternate-benefit downgrade applied even though billed correctly — D2750 or D2752 paid at the D2751 fee schedule per the PPO contract; this isn't a "denial" of D2751, but it's the most common reason a noble or high-noble PFM claim returns a payment that looks like a base-metal fee. The patient owes the contracted difference unless the office writes it off.
Insufficient full-coverage rationale — chart says "broken tooth #14, crown placed" with no description of cusp involvement, remaining structure, or why a large composite or onlay was inadequate. Carrier alternate-benefits to a D2393/D2394/D2544 fee or denies as "restoration adequate."
No pre-op imaging — many PPO carriers require a pre-op periapical or bitewing showing the lesion, fracture, or failed restoration before paying any D2750-series claim. Submitting without imaging is a common reason for a request-for-records denial.
Routine D2950 with D2751 (no missing structure) — a buildup billed alongside every crown without a documented missing-structure narrative or a post-prep photo. Carriers and OIG audits both flag this pattern; the buildup is recouped and the practice can be flagged for a broader audit.
Crown over symptomatic / endodontically-failing tooth — D2751 placed on a tooth with documented apical pathology or unresolved symptoms with no endo plan. Recouped on chart review and grounds for state-board review in egregious cases.
Crown over periodontally-hopeless tooth — D2751 placed on a tooth with Class III mobility, ≥7 mm probing depths, or radiographic bone loss to the apex. Recouped on perio chart review.
Nickel-allergy chart silence — chart fails to document allergy screening before a base-metal PFM. Specific to state-board review and patient-complaint cases more than to claim denial, but still a chart-deficiency finding.
Alloy mismatch with lab slip — D2750 or D2752 billed but lab slip shows base alloy (or vice versa). Recouped to the alloy actually used; some carriers also flag the practice for repeat audit.
Implant restoration miscoded as D2751 — a cement-retained crown over an implant abutment billed as D2751 instead of D6058–D6062. Implant codes have separate fee schedules and frequency rules; recoupment plus a billing-pattern flag.
Provisional / D2799 billed alongside D2751 — provisional crown billed at the prep visit and definitive D2751 billed at cementation. Most carriers bundle the provisional into D2751 unless the provisional is documented as long-term (months) for endo, perio, or ortho reasons.
Bundled with same-tooth same-day procedure — D2751 submitted with D2391 or D2150 on the same tooth/date, where the direct restoration would be inclusive of the crown prep.