Core buildup (D2950) — payer documentation requirements

Other payer records without an extracted rule for this procedure

An absent record does not mean the payer has no policy. It means Dentovio has not extracted a rule for this procedure from that payer's material — and in several cases a verifier read the payer's public criteria in full and found no entry for the code, which is recorded in that payer's notes below rather than invented as a rule.

• Delta Dental of New Jersey — Public — no login. Delta Dental of New Jersey is a separate member company from the Delta Dental Insurance enterprise recorded above — do not read one company's criteria onto the other. The handbook edition Dentovio read is the 2023 participating-dentist edition; confirm a newer edition before relying on it, and confirm the group's own contract, which the handbook says can vary. Delta Dental of New Jersey Participating Dentist Handbook, 2023 edition (PDF)
• Delta Dental of Arkansas (Delta Dental Smiles, Arkansas Medicaid) — Public — no login. This record covers Arkansas Medicaid only and is a different member company from the two Delta Dental records above. The manual carries no confidentiality marking. Children's and adult exclusion wording differ in places and must not be quoted for one another. Delta Dental Smiles Provider Manual V12, Delta Dental of Arkansas (PDF)
• MetLife — Provider portal login required. MetLife is the one payer here whose criteria Dentovio cannot read: the provider portal is credential-gated and the official public copy of the resource manual was unavailable on every attempt, so no scaling, crown or post-and-core rule is published under MetLife's name here. The one record that exists comes from a plan sponsor's summary plan description, not from MetLife's own policy library, and is scoped that way. An absent MetLife record means Dentovio could not read the document, never that MetLife has no rule. MetLife dental provider portal (current criteria; single sign-on required)
• United Concordia — Public — no login. United Concordia's clinical policy is public, not portal-gated — what is gated is a different artifact, the commercial Dentist Reference Guides. The policy is stamped proprietary and prohibits dissemination beyond limited individual-use copying, so Dentovio paraphrases and links rather than reproducing it. Localized antimicrobial delivery is genuinely absent from the public PPO policy. Rules read from the DE/PA/WV Medical Assistance guide are state Medicaid program rules and do not describe a commercial PPO patient's plan, and United Concordia states that where its policy conflicts with the member's benefit plan, the plan governs. United Concordia Dental Clinical Policy (PPO), last update 5.1.26 — public behind a no-login acknowledgement (PDF)
• DentaQuest (Medicaid/CHIP administrator) — Public — no login. Medicaid programs also apply the state's own criteria (for example TMHP in Texas). For members under 21, federal EPSDT coverage rules apply on top of the ORM, and requests to exceed a listed limit can be prior authorized with documentation of medical necessity. Three distinctions decide whether a rule applies to your patient: the member subgroup (child, adult state plan, or IDD waiver), the review type (prior authorization, post-treatment pre-payment review, or none), and the state. DentaQuest's office reference manuals stamp themselves proprietary and confidential despite being publicly hosted, so Dentovio paraphrases and links rather than reproducing their tables. DentaQuest Colorado Health First Office Reference Manual (PDF)
• MCNA Dental (Medicaid/CHIP administrator) — Public — no login. MCNA's Texas book is a children's Medicaid (Texas Health Steps / EPSDT) and CHIP dental plan covering birth through age 20. It contains no adult benefit rows at all, so it cannot support any statement about adults 21 and over — Texas adult dental sits outside MCNA entirely. The manual is public and carries no confidentiality marking. Every listed limit is an EPSDT floor that can be exceeded with a prior authorization documenting medical necessity, and the Medicaid and CHIP chapters carry different rules for the same codes. MCNA Texas Medicaid and CHIP Provider Manual v1.31, effective March 1, 2026