Deltadentalofohio Coverage Criteria
Latest Deltadentalofohio coverage criteria updates23
- Coverage CriteriaClinical/Medical PolicyEff. 2025-06-21Clinical Criteria Frenectomy and FrenuloplastyClinical criteria for evaluating the medical necessity and clinical appropriateness of frenectomy, frenulectomy, and frenuloplasty when benefit payment requires utilization management review.All deltadentalofohio updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-06-21Clinical Criteria for AlveoloplastyEstablishes clinical criteria for determining the medical necessity and clinical appropriateness of alveoloplasty when benefit payment requires utilization management review for Delta Dental of Ohio members, subject to applicable dental plan provisions and laws or regulations.All deltadentalofohio updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-06-21Clinical Criteria for Anesthesia and Intravenous SedationEstablishes clinical criteria for determining the medical necessity and clinical appropriateness of general anesthesia, deep sedation, and intravenous moderate conscious sedation provided with dental procedures.All deltadentalofohio updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-06-21Clinical Criteria for Appropriateness of CareThis policy establishes clinical criteria used by Delta Dental of Ohio dental peer reviewers to evaluate whether dental procedures were inadvisable, clinically deficient, inadequately documented, incomplete, or never performed. It applies when benefit payment requires an appropriateness-of-care review and does not determine whether a procedure is covered under an individual dental plan.All deltadentalofohio updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-06-21Clinical Criteria for Caries Arresting and Preventive MedicamentsThis policy establishes clinical criteria, documentation requirements, coverage considerations, and coding guidance for applying caries arresting medicaments, including silver diamine fluoride, and tooth-specific caries preventive medicaments. It applies to providers seeking benefit payment when Delta Dental of Ohio must determine whether these services are medically necessary and clinically appropriate.All deltadentalofohio updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-06-21Clinical Criteria for CoronectomyEstablishes clinical criteria for determining the medical necessity and clinical appropriateness of coronectomy for impacted teeth when complete extraction may risk neurovascular injury.All deltadentalofohio updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-06-21Clinical Criteria for Direct RestorationsEstablishes clinical criteria, documentation requirements, coding guidance, and utilization management considerations for direct dental restorations, including amalgam and resin-based composite restorations.All deltadentalofohio updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-06-21Clinical Criteria for Endodontic Therapy (Permanent Teeth)Establishes clinical criteria, documentation requirements, coding guidance, and coverage considerations for evaluating the medical necessity and clinical appropriateness of endodontic therapy for Delta Dental of Ohio members.All deltadentalofohio updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-06-21Clinical Criteria for Extraction of TeethThis policy establishes clinical and documentation criteria Delta Dental of Ohio uses to evaluate the medical necessity and clinical appropriateness of tooth extraction procedures when benefit payment requires utilization management review. It applies to dental providers submitting extraction claims or prior authorization requests under applicable member dental plans.All deltadentalofohio updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-06-21Clinical Criteria for Fixed Partial DenturesEstablishes clinical criteria for determining the medical necessity and clinical appropriateness of fixed partial denture treatment, including bridges, retainers, pontics, repairs, and related prosthodontic services, when the member's dental plan requires clinical review.All deltadentalofohio updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-06-21Clinical Criteria for Gingival Flap ProcedureClinical criteria used to determine the medical necessity and clinical appropriateness of gingival flap procedures when benefit payment requires utilization management review, subject to applicable plan provisions and program-specific criteria.All deltadentalofohio updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-06-21Clinical Criteria for GingivectomyCriteria for medical necessity, clinical appropriateness, documentation, and prior authorization for gingivectomy and gingivoplasty, subject to member benefit plans and applicable requirements.All deltadentalofohio updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-06-21Clinical Criteria for Hydroxyapatite RegenerationClinical and medical-necessity criteria for hydroxyapatite regeneration, including qualifying indications, documentation requirements, and circumstances that may result in benefit disapproval.All deltadentalofohio updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-06-21Clinical Criteria for Periodontal MaintenanceThis policy establishes clinical criteria for determining the medical necessity and clinical appropriateness of periodontal maintenance, including eligibility, clinical quality, documentation, and benefit limitations. It applies to providers submitting periodontal maintenance for benefit payment under a member's dental plan.All deltadentalofohio updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-06-21Clinical Criteria for Periodontal Osseous SurgeryEstablishes clinical criteria used to evaluate the medical necessity and clinical appropriateness of periodontal osseous surgery when a member’s dental plan requires clinical review.All deltadentalofohio updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-06-21Clinical Criteria for Periodontal Regenerative TreatmentEstablishes clinical criteria for determining the medical necessity and clinical appropriateness of periodontal regenerative treatment, including bone replacement grafts, biologic materials, and guided tissue regeneration, when clinical review is required by a member’s dental plan.All deltadentalofohio updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-06-21Clinical Criteria for Periodontal Scaling and Root PlaningEstablishes clinical and documentation criteria for medical necessity and clinical appropriateness of nonsurgical periodontal scaling and root planing when utilization management or prior authorization applies.All deltadentalofohio updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-06-21Clinical Criteria for Prefabricated CrownsEstablishes clinical criteria for determining the medical necessity and clinical appropriateness of prefabricated crown placement when a member's dental plan requires utilization review; it does not itself guarantee plan benefit coverage.All deltadentalofohio updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-06-21Clinical Criteria for Removable Complete DenturesClinical, medical-necessity, documentation, prior-authorization, coding, and benefit-administration criteria for removable complete dentures and related repairs, relines, rebases, replacements, and routine post-delivery care.All deltadentalofohio updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-06-21Clinical Criteria for Removable Partial DenturesEstablishes clinical criteria, prior authorization and documentation requirements, applicable CDT codes, and medical-necessity considerations for removable partial dentures in Delta Dental of Ohio benefit determinations.All deltadentalofohio updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-06-21Clinical Criteria for Restorative SubstructuresClinical criteria, documentation requirements, and utilization-management rules for core buildups, posts and cores, and related restorative substructures used with crowns or fixed partial denture retainer crowns.All deltadentalofohio updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-06-21Clinical Criteria for Single Crown RestorationsClinical and documentation criteria for determining whether single crown restorations are medically necessary and clinically appropriate for Delta Dental of Ohio members when utilization management review is required.All deltadentalofohio updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-05-09Clinical Criteria for Non-Pharmacologic Behavior ManagementEstablishes clinical criteria for determining the medical necessity and clinical appropriateness of non-pharmacologic behavior guidance, including basic techniques and advanced protective stabilization, and governs provider documentation and coverage determinations when plan review is required.All deltadentalofohio updates
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Tool Description
Search Deltadentalofohio coverage criteria and medical necessity requirements across 21,000+ policies from 170+ payers.
Search a drug (“Wegovy”), a procedure (“knee replacement”), or a policy name, then filter by payer, specialty, policy type, or effective year. Or start from the largest publishers: UnitedHealthcare coverage criteria and Cigna coverage criteria.
Each result links the full policy page, which lists the clinical requirements, covered codes, and effective dates from the source document.
Pair a criteria search with the prior authorization lookup for approval requirements, the timely filing lookup for claim deadlines, the live policy updates feed for the newest payer publications, and payer profiles for contacts and coverage context.
FAQ
Coverage criteria are the specific clinical requirements a payer sets for covering a drug, procedure, or service: diagnoses, symptom duration, prior treatments tried, age limits, and documentation. They are published inside medical policies and clinical criteria documents, and a claim or authorization that does not meet them is denied as not medically necessary.
Coverage Criteria by Payer
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Coverage policies are updated every day. Follow payer coverage policy updates in the live policy feed, or browse all CPT, HCPCS and DRG billing codes.
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