D5110 documentation requirements

Sourced answer

For complete dentures the published commercial criteria are documentary, not numeric. Aetna's claim-documentation guidelines contain no denture row at all and state that frequency limits, alternate-benefit provisions and missing-tooth provisions are plan terms. Cigna's 2026 guidelines carry only immediate- and interim-denture policies, neither with a frequency or radiograph requirement, and its office reference guide sets a 180-day same-office no-payment window for relines and repairs. Delta Dental Insurance's removable-prosthodontics section is general guidelines with clinical exclusions for untreated periodontal disease, hopeless abutments, unresolved periapical pathology, and vertical-dimension cases. Guardian's interval lives in its network dentist manual as either five or ten years by employer plan design, not in its clinical guidelines, and MetLife's criteria are unreadable behind a login — the one MetLife plan document Dentovio could read says ten years, not five. The hard numbers are Medicaid's: Arkansas allows one complete and one partial denture per arch per lifetime, Colorado one complete denture every seven years for adults, and United Concordia's DE/PA/WV Medical Assistance guide one per arch per five years under 21 with an adult lifetime limit.