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Dentovio public answer
For complete dentures the published commercial criteria are documentary, not numeric.
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.
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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