Benefit: Dental Services – Adults 21 years old and older

Definition: Emergency dental procedures to alleviate pain or infection, dentures and denture-related procedures.

Adult dental services include:

• Complete removable partial dentures;
• Comprehensive oral evaluation;
• Denture-related procedures;
• Full dentures;
• Incision and drainage of an abscess;
• Necessary extractions and surgical procedures to fit the mouth for dentures;
• Necessary x-rays/radiographs to make a diagnosis;
• Problem-focused oral evaluation; and
• Removable partial dentures.

Medicaid covers medically necessary emergency services.

Limits:  Evaluations for adults are limited to determining the need for dentures or for acute emergency services. Emergency services are limited to an emergency problem-focused evaluation, necessary x-rays to make a diagnosis, extraction, incision and drainage of an abscess.

Exceptions: None

Co-pays: Adult Medicaid beneficiaries are responsible for paying a 5 percent coinsurance charge for all procedures related to denture services, unless exempt.

Reform items that can vary: total annual amount can be limited; and co-pays can vary.