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Dentovio public answer
For crown claims (D2710–D2799), the published payer rules converge on one core requirement: a current, dated pre-operative radiograph — Delta Dental Ins. criteria specify a periapical (not panoramic) taken within one year of the prep, Aetna takes only duplicates that are unannotated and less than 36 months old, and Cigna pays when the evidence confirms decay or fracture too extensive for a filling. Aetna additionally qualifies a full crown on one of three clinical cases — 50% or more structural loss, an existing restoration covering half the tooth that needs replacing, or an endodontically treated tooth — excludes crowns placed strictly for cosmetic reasons, and may decline a tooth whose clinical crown is carious at or below the osseous crest. Replacement crowns also need the prior placement date and the reason for replacement. Confirm the current rule in the payer's own policy document linked on this page.
Dentovio is an independent publisher — not a dental payer, the ADA, or any state dental board. These summaries describe the payers' published clinical-review and documentation criteria as addressed to dentists — what a reviewer looks for on a claim, never what a patient's plan pays. Individual plan contracts govern: every payer document here states that the member's plan documents control coverage, frequencies and exclusions where they conflict with the policy, and payers revise policy documents on their own schedules. Where a record's reach is narrower than the payer — one plan line, one federal program, one state Medicaid program — or where a figure comes from a plan-sponsor or federal-program document rather than the payer's own policy manual, the record says so. Educational billing reference only, not billing, legal, or clinical advice. CDT codes are referenced by number only; CDT is the American Dental Association's copyrighted code set and this page does not reproduce ADA descriptors.
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