Does Delta Dental Cover CBCT Scans? Codes, Costs, and Appeals

Delta Dental PPO and Premier plans have covered cone beam computed tomography (CBCT) scans since January 1, 2024, with a limit of one scan per 12-month period.¹² Whether your particular plan actually pays depends on your employer’s contract and your coinsurance, and Delta Dental’s HMO-style DeltaCare USA plans do not appear to cover CBCT at all. The question is less “does Delta Dental cover it” and more “does your Delta Dental plan cover it.”

Which Delta Dental Plans Cover CBCT

Delta Dental’s 2023 announcement said CBCT capture and interpretation would be included in “all PPO policies” starting January 1, 2024, and a separate provider flyer confirms the benefit applies to both PPO and Delta Dental Premier plans.¹²

DeltaCare USA, the HMO-style product, is a different story. Benefit schedules for two large DeltaCare plans, one covering University of California employees and one covering San Francisco city employees, list hundreds of procedures and do not include CBCT codes anywhere.³⁴ If your card says DeltaCare, do not assume 3D imaging is included.

The Contract-Exclusion Catch

Even on the PPO side, coverage is not automatic for every member. The Delta Dental of North Carolina Dentist Handbook for 2026 describes CBCT codes D0364 through D0367 as “denied unless covered by contract,” which means the employer group or individual policy has to specifically include the benefit.⁵ Group and individual contract terms override the model processing policies.

A concrete example: the State Teachers Retirement System of Ohio holds a Delta Dental PPO plan that explicitly excludes “3-D scans and images.”⁶ Two people with Delta Dental PPO cards can get opposite answers on the same scan.

The Codes and the Once-A-Year Limit

Delta Dental recognizes these CDT codes for CBCT:

D0364: capture and interpretation, limited field of view (less than one whole jaw)
D0365: capture and interpretation, one full dental arch, mandible (lower jaw)
D0366: capture and interpretation, one full dental arch, maxilla (upper jaw), with or without cranium
D0367: capture and interpretation, both jaws, with or without cranium
D0391: interpretation of a diagnostic image by a different practitioner than the one who captured it

All four capture-and-interpretation codes (D0364 through D0367) are limited to one scan per 12-month period, and only one of the four can be billed in that window. A D0364 scan in March followed by a D0367 scan in October of the same year would get the second claim denied.²⁵

A separate TMJ-specific CBCT code, D0368, is denied unless your contract explicitly includes TMJ coverage, and even then it is limited to once per lifetime.⁵

What You Will Pay Out of Pocket

Delta Dental has not published a single coinsurance percentage for CBCT. Its provider flyer says only that “members may have out-of-pocket costs depending on their plan design and coinsurance.”² A broker-facing page ties the coinsurance to “major services,” which are often covered at 50 percent, though the exact split is set by the employer.⁷ One affiliate, Northeast Delta Dental, categorizes CBCT codes under “Diagnostic & Preventive,” which typically carries a higher coverage percentage.⁸ Classification varies among affiliates, so the only reliable number is the one on your own plan documents.

If you have no coverage at all, a dental CBCT scan generally runs between $100 and $700 depending on the field of view and location. A limited scan of a single area typically costs $150 to $350, while a full-mouth or TMJ scan can reach $400 to $700 or more.⁹ CBCT is an IRS-approved medical expense, so your share can be paid with HSA or FSA funds.⁷

Do You Need Prior Authorization

Generally no. Delta Dental of South Dakota describes pre-treatment estimates as voluntary and recommends them mainly for expensive work like crowns, implants, and oral surgery.¹⁰ The Washington state public employee plan serviced by Delta Dental says neither the Uniform Dental Plan nor DeltaCare requires preauthorization, though the treatment still has to be dentally necessary to qualify for benefits.¹¹

Even though it is not required, asking for a pre-treatment estimate before a CBCT scan is a smart move. You get a written answer on what the plan will pay, and any exclusion shows up before the scan rather than after.

How to Confirm Your Own Coverage

Because plan design varies so widely, four steps will give you a reliable answer:

Log in at deltadentalins.com or the Delta Dental app and look for codes D0364 through D0367 in your benefit summary.
Ask the dentist’s office to verify your eligibility through the Delta Dental Provider Tools portal before scheduling.²
Have the office submit a pre-treatment estimate for the specific scan code.¹⁰
Read the exclusions section of your certificate of coverage. If it lists “3-D scans and images,” the scan will not be covered regardless of clinical need.⁶

If Your CBCT Claim Is Denied

Start with the reason. A denial can mean your plan excludes 3D imaging altogether, that the 12-month frequency limit was already used, or that the claim was flagged by automated processing for missing documentation. Providers are told to contact Delta Dental’s Benefit Services Department for an explanation of the processing policy.¹²

If the problem was documentation, the dentist can submit an appeal with a clinical narrative and supporting radiographs to move the claim from automated processing to a manual review. Appeal procedures differ by Delta Dental affiliate, so the office will consult its handbook or provider relations for the right process.¹³ If the plan simply does not cover CBCT as a benefit, an appeal will not change the outcome, and the full fee falls to you.

1
Delta Dental Insurance Company. Cone Beam Technology
2
Delta Dental Insurance Company. Cone Beam Technology Provider Flyer
3
University of California. DeltaCare USA Plan Highlights
4
San Francisco Health Service System. DeltaCare USA Schedule of Benefits
5
Delta Dental of North Carolina. Delta Dental Dentist Handbook
6
State Teachers Retirement System of Ohio. Delta Dental Certificate of Coverage
7
Delta Dental Insurance Company. Cone Beam Technology Brokers
8
Northeast Delta Dental. The Incisor Newsletter, Fall-Winter 2023
9
Renew Digital. How Much Does a CBCT Scan Cost
10
Delta Dental of South Dakota. Your Guide to Pre-Treatment Estimates
11
Washington Health Care Authority. Delta Dental of Washington Preauthorization Requirements
12
Delta Dental of Virginia. Participating Dentists’ Handbook
13
American Association of Endodontists. Claims Guide