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Dentovio public answer
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.
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.
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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