# Dental claim documentation requirements by payer

> Payer-by-payer comparison of the published documentation rules for the most-reviewed dental claim families — scaling and root planing (D4341/D4342), crowns (D2710–D2799), and core buildup (D2950) — with a direct link to every source document.

URL: https://dentovio.com/dental-claim-documentation

Last verified: 2026-08-28

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; individual plan contracts still control coverage, frequencies, and exclusions, and payers revise policy documents on their own schedules. 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

Major dental payers publish real, different documentation rules for the most-reviewed procedures — and most denials in these families trace back to a submission that missed the specific payer's published threshold. Aetna, Cigna, the Delta Dental Ins. enterprise, United Concordia, and DentaQuest all publish their criteria openly (no provider login); MetLife's current guides and Guardian's criteria sit behind provider portals. This hub compares the published scaling-and-root-planing, crown, and core-buildup requirements payer by payer, with a direct link to every source document.

## The SRP threshold differences (why one checklist is wrong)

| Payer | Published SRP threshold |
| --- | --- |
| Aetna | Aetna's claim-documentation guidelines state that, in general, documented 5–8 mm pockets determine D4341/D4342 benefits |
| Cigna | Pocket depths 4 mm or deeper, plus radiographic bone loss |
| Delta Dental (Delta Dental Ins. enterprise) | Radiographic alveolar crest loss beyond the normal 1–1.5 mm CEJ distance |
| MetLife | Published charting + radiograph rules (no numeric threshold published) |
| United Concordia | Radiographically demonstrable bone loss |
| DentaQuest (Medicaid/CHIP administrator) | Radiographic bone loss ≥ 2.5 mm from the CEJ |

## Procedure pages

- [Scaling and root planing (D4341 / D4342)](https://dentovio.com/dental-claim-documentation/d4341-scaling-and-root-planing/index.html.md): SRP is among the most-reviewed procedure families in dental claims. Payers deny or downcode it when the submitted periodontal charting does not show their pocket-depth threshold, when radiographs do not demonstrate bone loss, or when the quadrant does not contain enough qualifying teeth.
- [Crowns (D2710–D2799)](https://dentovio.com/dental-claim-documentation/d2740-crowns/index.html.md): Crown claims fail when the pre-operative radiograph is missing, undated, or panoramic-only, when the submitted evidence does not show enough structural loss to rule out a filling, or when a replacement crown lacks the prior placement date and reason.
- [Core buildup (D2950)](https://dentovio.com/dental-claim-documentation/d2950-core-buildup/index.html.md): Payers routinely bundle D2950 into the crown fee. Without pre-operative evidence that the tooth lost enough structure to need a separate buildup, the bundle is usually final — this is the classic denial that documentation must prevent at submission, because it is rarely winnable afterward.

## Where each payer publishes its rules

| Payer | Access | Policy library |
| --- | --- | --- |
| Aetna | Public — no login | 44 Dental Clinical Policy Bulletins (DCPBs) plus a per-code Dental and Oral Surgery Claim Documentation Guidelines PDF, both public with no provider login. |
| Cigna | Public — no login | Complete Dental Clinical Coverage Determination Guidelines for DPPO and DHMO plans, published as annual-edition PDFs with named per-family policies (PERIO-16, REST-03). |
| Delta Dental (Delta Dental Ins. enterprise) | Public — no login | Clinical Criteria / utilization-management document covering Delta Dental of California, New York, Pennsylvania, Delaware, DC, and West Virginia, with a Procedure Codes that Require Documentation Submission table; the national Dentist Handbook is posted publicly by several member companies in annual editions. |
| MetLife | Archived public copy; current rules gated | The Preferred Dentist Program Resource Manual with a per-code Supporting Information table was historically served publicly; MetLife's current guides and fee schedules live behind the metdental.com provider login. |
| United Concordia | Public — no login | Public provider-education documents and help-center policy pages, including a dedicated scaling-and-root-planing claims guide. |
| Guardian | Provider portal login required | No public clinical-criteria or documentation-requirements document; the provider toolkit routes to the mydental.guardianlife.com portal login. |
| DentaQuest (Medicaid/CHIP administrator) | Public — no login | Per-state Office Reference Manuals (ORMs) with numeric clinical criteria, publicly downloadable (e.g., Colorado Health First, Indiana via Humana, Kentucky via Anthem, Medi-Cal via Health Net). |
| MCNA Dental (Medicaid/CHIP administrator) | Public — no login | Public, versioned per-state provider manuals (Texas Medicaid and CHIP Provider Manual; Florida Healthy Kids manual). |

## Related

- [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)
- [Dental CE requirements by state](https://dentovio.com/ce-requirements/index.html.md)