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Dentovio answer topic
Answers for California dental practice compliance, record retention, auxiliary scope, and Cal/OSHA references. This topic page groups 145 focused answer pages, source pages, markdown mirrors, and query patterns for the same search-intent cluster.
Showing 24 of 145. Use the answer bank or NDJSON feed above for the complete machine-readable set.
california-dental-practice-compliance
California dental compliance spans records, auxiliary scope, infection-control and Cal/OSHA obligations, and practice operations; use the compliance hub and linked topic pages for source-specific details.
california-dental-record-retention-requirements
California has no single statutory retention period for every private dental chart. HSC §123145's seven-year and minor-record periods apply only to providers licensed under four listed HSC provisions when they cease operation; Medi-Cal provider records follow a separate 10-year rule.
california-rda-scope-of-practice
California dental auxiliary scope depends on the auxiliary category and delegated duty; the state recognizes direct and general supervision under BPC section 1741, not an indirect-supervision category.
california-dental-osha-requirements-checklist
A California dental office typically keeps five written safety plans current: Infection Control, Exposure Control, Injury and Illness Prevention, Hazard Communication, and Radiation Safety, plus recurring training, logs, SDS access, eyewash, and sterilizer testing tasks.
dental-claim-documentation-by-payer
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.
d4341-scaling-and-root-planing-documentation-requirements
No payer document read for this page publishes a pocket-depth threshold for scaling and root planing. Aetna's DCPB041 carries no millimetre figure at all: it asks for periodontal charting recording pocket depths at six points per tooth with bleeding on probing, unannotated full-mouth radiographs, chart notes giving the appointment duration and the type and amount of local anesthetic, and diagnostic materials demonstrating clinical attachment loss, crestal bone loss or lamina dura change, and root-surface calculus. Delta Dental Insurance requires submitted charting dated no more than 12 months before treatment, and Cigna's PERIO-16 bars payment — and any patient charge — where the same office retreats a quadrant inside 24 months. The 4 mm figure common in billing content is a literature convention the ADA disclaims: it records that payers establish their own criteria, which can differ from payer to payer and from one customer to another inside a single payer's book of business, so two similar charts under different employer group policies can be adjudicated differently. Submit the charting, the images the payer names, and quadrant tooth counts that match the code, then confirm the current rule in the linked payer document.
d4910-periodontal-maintenance-documentation-requirements
Periodontal maintenance is adjudicated on treatment history and plan frequency, and the published rules differ by payer. Cigna's PERIO-20 allows it where there is a history of active periodontal therapy — D4210/D4211, D4240/D4241, D4260/D4261, or D4341/D4342 — or of a previously allowed maintenance visit, and states that plan frequency limitations may apply rather than publishing an interval. Aetna publishes no clinical policy bulletin on D4910 at all; its DMO plans cover it twice a year only with a history of periodontal surgery, with prior scaling and root planing qualifying since April 1, 2023, and a prophylaxis allowance otherwise. United Concordia's 2025 federal FEDVIP plan allows four combined cleanings a calendar year, five for members registered with a listed condition or pregnancy. Delta Dental Insurance expressly exempts maintenance from its 12-month periodontal-charting requirement, and MCNA's Texas children's program pays it once per 12 calendar months for ages 13 to 20 after active therapy.
d4260-osseous-surgery-documentation-requirements
For osseous surgery the published payer criteria are documentary and temporal rather than numeric. Delta Dental Insurance requires that the procedure include removal of supporting bone (ostectomy) and/or non-supporting bone (osteoplasty) with elevation of a full-thickness flap and closure, plus periodontal charting within 12 months. Guardian applies a generic periodontal-surgical-services standard — radiographs showing pathologic loss of alveolar crest height, periodontal charting, and exclusion of any tooth with 50% or more bone loss for poor prognosis. Aetna's DCPB012 states no pocket-depth, bone-loss, or prior-scaling requirement at all, and limits the benefit typically to one pocket-reduction surgery per quadrant or tooth in any 36 consecutive months. Cigna's office reference guide bars payment and any patient charge for same-office retreatment of a quadrant within 36 months, and United Concordia denies the claim as misreported where the quadrant does not show periodontal disease with moderate-to-deep pockets. Medicaid programs add age bands, prior authorization, and their own frequency caps.
d4249-crown-lengthening-documentation-requirements
Crown lengthening is denied most often as inclusive to another service rather than for missing documentation. Delta Dental's claim tips say to wait at least four weeks after crown lengthening before completing the restoration, and that no separate fee may be charged when the surgery is performed on the same day as the crown preparation — 9WA, meaning the fee is included in the fee for a completed service, is the denial code most often associated with it. Aetna identifies radiographic evidence of fracture or decay extending below or near the alveolar crest as the usual clinical indication, and treats crown lengthening performed with osseous surgery for periodontal disease as inclusive to that surgery. Guardian allows a benefit only where the tooth requires a full-thickness flap and bone removal to expose enough tooth structure to support a restoration. United Concordia limits it to one per tooth per lifetime with a pre-treatment x-ray and periodontal charting, and Medicaid programs add prior authorization, age bands, and healing-period rules.
d4381-localized-antimicrobial-delivery-documentation-requirements
Localized delivery of antimicrobial agents is a coverage question before it is a documentation question. Aetna states that D4381 is not a covered service in most of its dental plans and is not covered at all for members whose plan became effective after October 1, 2016; where a grandfathered plan covers it, the criteria are isolated refractory sites with pockets of 5 mm or greater and persistent inflammation, treated 6 weeks to 6 months after scaling and root planing, with sub-5 mm sites classified experimental and investigational. Cigna limits coverage to two teeth per quadrant. Delta Dental of New Jersey benefits it by individual consideration for no more than two refractory teeth per quadrant at pocket depths of at least 5 mm and less than 10 mm, either 6 weeks to 6 months after initial therapy or for a patient of record on maintenance, and some New Jersey plans exclude it outright. DentaQuest's Texas program allows one service every two years per tooth for ages 13 to 20 with prior authorization. United Concordia's and Guardian's public criteria documents contain no entry for this code.
d2740-crowns-documentation-requirements
For crown claims (D2710–D2799), the published payer rules converge on one core requirement: a current, dated pre-operative radiograph — Delta Dental Ins. criteria specify a periapical (not panoramic) taken within one year of the prep, Aetna takes only duplicates that are unannotated and less than 36 months old, and Cigna pays when the evidence confirms decay or fracture too extensive for a filling. Aetna additionally qualifies a full crown on one of three clinical cases — 50% or more structural loss, an existing restoration covering half the tooth that needs replacing, or an endodontically treated tooth — excludes crowns placed strictly for cosmetic reasons, and may decline a tooth whose clinical crown is carious at or below the osseous crest. Replacement crowns also need the prior placement date and the reason for replacement. Confirm the current rule in the payer's own policy document linked on this page.
d2950-core-buildup-documentation-requirements
Dental payers do publish D2950 criteria, and the required record differs by payer. Aetna calls for both pre-operative and post-operative imagery. Cigna allows a buildup when decay or fracture makes it necessary to retain the final restoration. Delta Dental Ins. calls for a periapical radiograph, photographs taken within one year, and a narrative. Guardian ties the benefit to a covered crown or bridge, documented substantial structural loss, and less than 3 mm of sound dentin remaining circumferentially after preparation. Bundling remains a risk when the submitted record does not establish the payer's separate-retention criteria.
d2952-post-and-core-documentation-requirements
Post and core is governed by bundling rules and imaging, and two payers publish an explicit downgrade. Guardian allows the benefit only in conjunction with a covered crown or bridge unit, only where less than 3 mm of sound dentin remains circumferentially after preparation, and may limit an indirectly fabricated post and core to the prefabricated allowance as the least expensive alternate treatment. Cigna publishes no post-and-core policy but bars a core buildup on the same date of service and the same tooth as a post and core. Delta Dental Insurance requires a periapical radiograph and a written report. United Concordia's DE/PA/WV Medical Assistance guide requires a post-endodontic x-ray in addition to the pre-treatment film, approvable only where tooth structure is insufficient for retention. Aetna carries no post-and-core row at all; its core-buildup bulletin is imaging-primary, and carious destruction of the clinical crown at or below the osseous crest is grounds for denial rather than support for a post.
d5110-complete-dentures-documentation-requirements
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.
d6240-fixed-partial-dentures-documentation-requirements
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.
d6010-implants-documentation-requirements
For implants the published payer criteria are qualitative: no payer document Dentovio read publishes a bone-height or bone-width figure, and none requires cone-beam imaging. Cigna considers surgical placement where there is a limited number of missing un-replaced teeth, typically three or fewer, may decline where conventional prosthetics can reasonably address the case — typically four or more missing un-replaced teeth — and limits a fully edentulous arch to three implants per quadrant and six per arch. Aetna lists the documentation, with no narrative required, and requires other active periodontal disease to be treated and under control before immediate placement in an extraction site. Delta Dental Insurance's imaging requirement is post-operative, and its dimensional rule is qualitative. Guardian publishes no implant criteria at all beyond a coverage-election statement and a bundling rule. In Medicaid, DentaQuest's Colorado program covers implants only under the intellectual-and-developmental-disability waiver, with Class I or II bone and no daily tobacco use, and MCNA's Texas program removed the implant codes from its covered grid in 2016.
d7140-extractions-documentation-requirements
Surgical-extraction downcoding is the recurring denial here, and the published rules agree on the reason. Aetna defines surgical removal as cutting the gingiva for flap design and removing bone for access to non-diseased tooth structure, and gives no surgical benefit for periodontally involved teeth with excessive bone loss or exposed roots — the downcode targets are D7140 or D7111, applied after review rather than automatically. Guardian states that coding for impacted teeth follows the anatomic position of the tooth, not the technique used, and may limit a surgical extraction to the D7140 benefit when performed with another surgical procedure in the same site. United Concordia re-benefits impactions by bone coverage: partially bony above 50% of the anatomical crown, completely bony above 75%. Delta Dental Insurance requires periapical or panoramic radiographs and tooth-specific chart notes from D7210 upward, with no submission requirement for a simple D7140. Aetna's third-molar bulletin puts the prudent removal window before age 25 and rejects anterior crowding as an indication.
dental-claim-denial-codes
Dental remittances pair a CARC reason number with a group code — CO, PR, OA, or PI — and the group code, not the CARC, assigns financial responsibility. X12 fixes the group code for only two of these codes: 18 may be used only with OA except where state workers' compensation law requires CO, and 45 only with PR or CO depending on liability. For every other code the payer chooses the group code under its own contract, so read the one on the remittance rather than assuming it from the number. This reference covers 39 codes with their registry dates and paired remark codes, each verified against a named payer crosswalk or the CAQH CORE combinations, with the absence stated where no source pairs them. Correction codes such as 16, 18, and 251 call for fixing the submission, plan exclusions and benefit limits turn on contract terms, and a documentation dispute can be contested when the record meets the payer's published criteria. The appeal route depends on plan funding: state law and plan terms for fully insured plans, 29 CFR 2560.503-1 for self-funded ERISA plans, and 42 CFR 438.402/438.408 for an enrollee's Medicaid managed-care benefit appeal. Provider payment and contract disputes follow the provider contract and state Medicaid process instead.
dental-denial-code-carc-16
On a dental remittance, CARC 16 means: Processing stopped because a required claim detail is absent or a billing or submission field is defective. The accompanying remark code identifies the problem; a different CARC applies when an attachment itself is missing. X12 assigns it no group code, so the group code on the remittance is the payer's choice under its own contract and it, not the CARC, decides who is assigned the balance. The code's own definition requires an accompanying remark code, so a remittance carrying it without one is incomplete. Remark codes verified with it: N286, N265, N253, M53, MA36, M64, N4. Dentovio's appealability verdict — technical: fix and resubmit. This is usually not an appeal situation — correct the identified element and resubmit. Track the payer's timely-filing window while you fix it: a corrected claim must still land inside it.
dental-denial-code-carc-4
On a dental remittance, CARC 4 means: The modifier on the line does not fit the procedure code it was attached to, so the payer stopped on the pairing rather than on the procedure itself. X12 assigns it no group code, so the group code on the remittance is the payer's choice under its own contract and it, not the CARC, decides who is assigned the balance. No source read for this page pairs a specific remark code with it. Dentovio's appealability verdict — technical: fix and resubmit. A code-and-modifier mismatch is corrected, not appealed. Establish which modifier list governs the claim — the payer's own list for a fee-schedule claim, the state's published modifier list for an institutional Medicaid claim — before changing anything.
dental-denial-code-carc-11
On a dental remittance, CARC 11 means: The diagnosis reported on the claim does not, in the payer's edit, support the procedure billed alongside it. X12 assigns it no group code, so the group code on the remittance is the payer's choice under its own contract and it, not the CARC, decides who is assigned the balance. No source read for this page pairs a specific remark code with it. Dentovio's appealability verdict — depends: check the facts first. If the diagnosis was simply coded wrong, correct it and resubmit. If the diagnosis is right and the payer's edit rejects the pairing anyway, that becomes a documented-necessity dispute rather than a coding fix.
dental-denial-code-carc-a1
On a dental remittance, CARC A1 means: A general denial with no more specific reason code available. X12 tells payers to use it only as a fallback, and requires a remark code alongside it — so the actual reason lives in the remark, not in A1. X12 assigns it no group code, so the group code on the remittance is the payer's choice under its own contract and it, not the CARC, decides who is assigned the balance. The code's own definition requires an accompanying remark code, so a remittance carrying it without one is incomplete. No source read for this page pairs a specific remark code with it. Dentovio's appealability verdict — depends: check the facts first. There is no verdict on A1 itself. Read the required remark code — X12 allows either a non-alert remark code or an NCPDP reject reason code — and triage on that. If no remark arrived, the remittance is non-compliant and the first move is to ask the payer for the reason in writing.
dental-denial-code-carc-252
On a dental remittance, CARC 252 means: The payer cannot finish adjudicating without documentation it has not received, and must name what is missing in an accompanying remark code. X12 restricts its group code to CO or PI. The code's own definition requires an accompanying remark code, so a remittance carrying it without one is incomplete. Remark codes verified with it: N401, N706, N928, N931. Dentovio's appealability verdict — technical: fix and resubmit. Send what was asked for rather than arguing the decision. Work from the payer's own published documentation requirements for the procedure so the resubmission cannot be judged deficient a second time, and watch the response window — leaving the request unanswered turns a 252 into a 226.
dental-denial-code-carc-251
On a dental remittance, CARC 251 means: The payer received supporting material, but its contents lacked information needed to finish processing the claim. X12 assigns it no group code, so the group code on the remittance is the payer's choice under its own contract and it, not the CARC, decides who is assigned the balance. Remark codes verified with it: N402. Dentovio's appealability verdict — technical: fix and resubmit. Respond with the complete documentation rather than an appeal letter — and use the payer's published documentation checklist for the procedure so the resubmission cannot be judged deficient twice. The paired remark code identifies what was missing.
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