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Dentovio public answer
Dental payers do publish D2950 criteria, and the required record differs by payer.
Dental payers do publish D2950 criteria, and the required record differs by payer. Aetna calls for both pre-operative and post-operative imagery. Cigna allows a buildup when decay or fracture makes it necessary to retain the final restoration. Delta Dental Ins. calls for a periapical radiograph, photographs taken within one year, and a narrative. Guardian ties the benefit to a covered crown or bridge, documented substantial structural loss, and less than 3 mm of sound dentin remaining circumferentially after preparation. Bundling remains a risk when the submitted record does not establish the payer's separate-retention criteria.
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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