dental frequency limitations

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A frequency limitation caps how often a plan pays for a service, and it is a contract term rather than a payer standard: Guardian publishes no frequency figure at all and states that plan documents are the final arbiter of coverage, and Aetna publishes no crown frequency baseline in any of its dental clinical policy bulletins. Verified in named documents: crown replacement windows run from 24 months to 10 years — 24 and 36 months for prefabricated and stainless steel crowns on one Guardian Utah plan, 36 months in South Carolina Medicaid, five years on Aetna's California DMO and in both United Concordia government programs, 60 months on one Delta Dental Insurance Company group PPO, 84 months in Colorado Medicaid, and 10 years on one MetLife-authored plan-summary form. Preventive rules differ in kind as well as number: one DentaQuest Ohio policy gives under-19 members a six-month interval and adults twice per calendar year, one Delta group plan pays examinations, cleanings, periodontal maintenance, and scaling in the presence of inflammation twice per calendar year in any combination, and MetLife's federal plan moved routine exams and cleanings from one in six months to two in twelve months for 2026 while capping replacement fillings at one in 24 months. The counting method matters as much as the allowance — calendar year, rolling 12 months, or six months from the last date of service — and prior-carrier service dates can count against the clock. Waiting periods, annual maximums, and program caps frequently bind before any frequency rule does.