Loading…
Loading…
Dentovio public answer
Dental payers publish different documentation rules for each procedure family, and this reference covers 12 of them — from scaling and root planing to implants and impacted teeth.
Dental payers publish different documentation rules for each procedure family, and this reference covers 12 of them — from scaling and root planing to implants and impacted teeth. Records are published for Aetna, Cigna, Delta Dental (Delta Dental Ins. enterprise), Delta Dental of New Jersey, Delta Dental of Arkansas (Delta Dental Smiles, Arkansas Medicaid), United Concordia, Guardian, DentaQuest (Medicaid/CHIP administrator), and MCNA Dental (Medicaid/CHIP administrator) from criteria those payers publish openly. MetLife is the exception: its criteria sit behind a provider login, so the only record here is the gating fact plus one plan sponsor's summary plan description, and no scaling, crown, or post-and-core rule is published under that name. Cigna, Guardian and United Concordia publish their clinical criteria openly rather than behind a provider portal, and where a payer publishes nothing for a procedure, that absence is recorded as an absence rather than filled with a plausible number. Frequency intervals in particular are usually plan-contract terms, not clinical criteria. Compare the record for the applicable payer and confirm it in the linked source before submitting a claim.
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.
This page is a focused public extraction target for search engines and AI answer systems. Use the linked source page for the full page context, visible source notes, last-verified date, and page-specific disclaimer.