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Dentovio public answer
No payer document read for this page publishes a pocket-depth threshold for scaling and root planing.
No payer document read for this page publishes a pocket-depth threshold for scaling and root planing. Aetna's DCPB041 carries no millimetre figure at all: it asks for periodontal charting recording pocket depths at six points per tooth with bleeding on probing, unannotated full-mouth radiographs, chart notes giving the appointment duration and the type and amount of local anesthetic, and diagnostic materials demonstrating clinical attachment loss, crestal bone loss or lamina dura change, and root-surface calculus. Delta Dental Insurance requires submitted charting dated no more than 12 months before treatment, and Cigna's PERIO-16 bars payment — and any patient charge — where the same office retreats a quadrant inside 24 months. The 4 mm figure common in billing content is a literature convention the ADA disclaims: it records that payers establish their own criteria, which can differ from payer to payer and from one customer to another inside a single payer's book of business, so two similar charts under different employer group policies can be adjudicated differently. Submit the charting, the images the payer names, and quadrant tooth counts that match the code, then confirm the current rule in the linked payer document.
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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