# Post and core (D2952 / D2954) — payer documentation requirements

> What documentation do dental payers require for post and core (D2952 / D2954) claims? The published rules, payer by payer, with a direct link to every source document.

URL: https://dentovio.com/dental-claim-documentation/d2952-post-and-core

Last verified: 2026-08-30

Dentovio is an independent publisher — not a dental payer, the ADA, or any state dental board. This page was drafted with AI assistance and verified against the primary sources linked here. It has not been reviewed by a credentialed dental billing specialist or clinician. 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.

## Direct answer

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.

## Why these claims get denied

Post-and-core pay is decided by what else is billed the same day and by imaging. Two payers publish an explicit downgrade from an indirectly fabricated post to the prefabricated allowance, and one bars a core buildup on the same tooth and date.

## Requirements by payer

### Aetna

Aetna's claim-documentation guidelines carry no post-and-core row at all; the adjacent core-buildup bulletin is imaging-primary, and destruction of the clinical crown at or below the osseous crest is grounds for denial rather than support for a post.

- D2952 and D2954 do not appear in the claim-documentation guidelines; the guidelines carry a core-buildup row instead, which calls for pre-operative and post-operative photographs or radiographs showing the buildup in place
- Aetna's core-buildup bulletin is imaging-primary: narratives may support the images but do not substitute for them and are not the sole determinant of coverage
- A restoration built to occlusion with functioning anatomy and interproximal contacts is not considered a core buildup
- Core buildups are not benefited when submitted with inlays or onlays
- Restorative services may not be covered for teeth with a poor or questionable prognosis from poor restorability or carious destruction of the clinical crown at or below the osseous crest — that finding is a denial criterion, not documentation supporting a post

Verified 2026-08-30. Read from:

- [Aetna Dental and Oral Surgery Claim Documentation Guidelines, last updated July 21, 2025 (PDF)](https://www.aetna.com/content/dam/aetna/pdfs/aetna-dental/claim-documentation-guidelines.pdf)
- [Aetna DCPB043 — Core buildup, reviewed March 24, 2025 (Background and Codes sections)](https://www.aetna.com/health-care-professionals/clinical-policy-bulletins/dental-clinical-policy-bulletins/DCPB043.html)

### Cigna

Cigna publishes no post-and-core policy; the codes appear only on the list of restorative codes that require X-ray submission, and the operative rule is that a core buildup cannot be paid on the same date and tooth as a post and core.

- Neither 2026 guideline contains a post-and-core policy; the post-and-core codes appear only on the list of restorative codes requiring X-ray submission, with no film type, no date requirement, and no root-canal-fill criterion attached
- A core buildup is not allowable when completed on the same date of service and the same tooth as a post and core — the bar is same date and same tooth, not a blanket prohibition on the pair
- The only qualitative imaging standard stated is that all radiographs should be of diagnostic quality, and Cigna reserves the right to request additional films
- Claims should be submitted only for completed services: insertion dates are required for crowns, bridges and dentures, and submitting on a preparation date causes related same-day services to be denied as inclusive

Verified 2026-08-30. Read from:

- [Cigna Dental Clinical Coverage Determination Guidelines — DPPO, May 2026 re-issue, form 999493 05/26 (PDF)](https://campaigns.cigna.com/static/campaigns-cigna-com/docs/dental-hcpemails/Clinical%20Documents/Cigna%20Dental%20Coverage%20Determination%20Guidelines%20DPPO%206-2026.pdf)
- [Cigna Dental PPO dental office reference guide, form 988135 12/25 (PDF; also via CignaforHCP.com › Resources › Reference Guides)](https://static.cigna.com/assets/chcp/secure/pdf/resourceLibrary/dental/DPPODentalOfcRefGuide.pdf)

### Delta Dental (Delta Dental Ins. enterprise)

Delta Dental Ins. requires a periapical radiograph and a written report for post and cores; the photographs requirement attaches to buildups, crowns, cracked teeth and anterior restorations, not to post and core.

- Submission of a periapical radiograph and a written report is required for post and cores
- Photographs must accompany radiographs when determining cracked teeth, build-ups, crowns and anterior restorations where necessity is not obvious on the radiographs — the requirement is not stated for post and core

Verified 2026-08-30. Read from:

- [Delta Dental Ins. Clinical Criteria / Utilization Management, Section 4, effective January 1, 2025 pending state regulatory approval (PDF)](https://www1.deltadentalins.com/content/dam/ddins/en/pdf/dentists/provider-tools/clinical-criteria-utilization-management.pdf)

### United Concordia

Under United Concordia's DE/PA/WV Medical Assistance guide a post and core needs a post-endodontic x-ray in addition to the pre-treatment film, and is approvable only where there is not enough tooth structure to retain the restoration.

- An indirectly fabricated or prefabricated post and core requires a post-endodontic diagnostic x-ray in addition to a pre-treatment diagnostic x-ray of the tooth
- The service is approvable only alongside an approved prefabricated post-and-core code where there is not enough tooth structure and a post is placed to aid retention and stability for a core buildup
- Additional x-rays, written documentation, photographs and other diagnostic materials beyond the required list are optional and should corroborate the evidence in the required materials
- Scope: United Concordia's public DE/PA/WV Medical Assistance guide — Highmark Wholecare PA, Highmark Health Options DE and WV Medicaid, DHCP and WV CHIP. Not a commercial PPO rule.

Verified 2026-08-30. Read from:

- [United Concordia Dental Reference Guide — Medical Assistance DE, PA, WV, Volume 2026 Issue 1 (PDF)](https://www.unitedconcordia.com/content/dam/ucd/en/commercial/website/docs/dentists/DE-PA-WV-Medicaid-DRG.pdf)

### Guardian

Guardian ties post and core to a covered crown or bridge unit, sets a measured structural test — less than 3 mm of sound dentin circumferentially — and may pay an indirectly fabricated post at the prefabricated allowance.

- Benefit may only be allowed when done in conjunction with a covered crown or bridge unit and when documentation confirms substantial loss of natural tooth structure
- Allowed only where there is insufficient circumferential tooth structure to retain a full-coverage indirect restoration — less than 3 mm of sound dentin remaining circumferentially after tooth preparation
- Benefit for an indirectly fabricated post and core may be limited to the prefabricated post-and-core allowance as the least expensive alternate treatment
- Every submission in this section must include current diagnostic pre-operative periapical and/or bitewing x-rays, patient chart notes, and any relevant intraoral photographs; a pre-treatment estimate is recommended
- Guardian states that narratives, letters and remarks made on the claim form or on x-rays are not the best source for additional information, and that progress or chart notes alone are not sufficient
- Published threshold: Less than 3 mm of sound dentin remaining circumferentially after tooth preparation.

Verified 2026-08-30. Read from:

- [Guardian Dental Clinical Guidelines 2026, updated August 12, 2026 (PDF)](https://storage.pardot.com/503851/1786988624j5KmwrmM/Dental_Clinical_Guidelines_2026_August.pdf)

## Other payer records without an extracted rule for this procedure

An absent record here 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 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. Policy library: [Delta Dental of New Jersey Participating Dentist Handbook, 2023 edition (PDF)](https://www.deltadentalnj.com/-/media/DDNJ/Handbook/Delta_Dental_NJ_Participating_Dentist_Handbook.ashx)
- 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. Policy library: [Delta Dental Smiles Provider Manual V12, Delta Dental of Arkansas (PDF)](https://www.deltadentalar.com/docs/default-source/smiles-provider-resources/smiles-provider-manual-r12.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. Policy library: [MetLife dental provider portal (current criteria; single sign-on required)](https://dentalprovider.metlife.com/)
- 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. Policy library: [DentaQuest Colorado Health First Office Reference Manual (PDF)](https://www.dentaquest.com/content/dam/dentaquest/en/providers/colorado/co-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. Policy library: [MCNA Texas Medicaid and CHIP Provider Manual v1.31, effective March 1, 2026](https://manuals.mcna.net/texas)

## Related

- [All payer documentation requirements](https://dentovio.com/dental-claim-documentation/index.html.md)
- [Dental claim denial codes](https://dentovio.com/dental-claim-denial-codes/index.html.md)
- [Dental insurance prompt-pay laws by state](https://dentovio.com/dental-prompt-pay-laws/index.html.md)