D6205 documentation requirements

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For fixed partial dentures no payer here publishes a replacement interval in its clinical criteria — the published rules are about abutments, prior tooth loss, and alternate benefits. Cigna allows replacement of an unserviceable bridge with open margins, recurrent decay, or restorative-material failure, and its published alternate-benefit example reimburses a fixed bridge at the partial-denture fee where a partial would restore the teeth satisfactorily. Guardian allows a benefit only to replace a tooth extracted while the member was insured with the plan, requires the prior carrier's explanation of benefits after a group transfer, and may limit the bridge to the removable-partial allowance where two or more posterior teeth are missing bilaterally. Delta Dental Insurance requires a pre-operative periapical taken within one year of the preparation — not a panoramic — and declines a posterior bridge plus a removable partial where three or more teeth are missing in contralateral quadrants. Aetna asks for full-mouth or panoramic pre-operative radiographs, extraction dates, the prior prosthetic placement date and rationale, and the numbers of all missing teeth. Virginia's Medicaid program excludes bridges for adults entirely.