Benefit: Dental Services – Children 20 and Under

Definition: Dental procedures performed by a licensed, Medicaid participating dentist. Services include:

• Dentures, complete and partial;
• Diagnostic examinations;
• Endodontic (deals with the tooth insides and the tissues surrounding the root of a tooth)/ Periodontal (deals with diseases and conditions that affect the tooth’s supporting structure such as gums and jawbone) treatment;
• Oral surgery;
• Orthodontic (deals with tooth alignment from an improper bite) treatment;
• Periodontal (deals with diseases and conditions that affect the tooth’s supporting structure such as gums and jawbone) services;
• Preventive services;
• Restorations; and
• X-rays/radiographs necessary to make a diagnosis.

Limits:  Medicaid does not reimburse for the following services:
Fixed bridge work or sealants applied to deciduous (baby) teeth. Medicaid reimburses for the application of sealants on permanent first and second molars once per three years, per tooth.

For orthodontics, Medicaid services are limited to treatment of severe malocclusions or correction of a dental condition deterring physical development.

Prior authorization is required for partial dentures and all orthodontic services except the initial evaluation.

Exceptions: None

Co-pays: None

Reform items that can vary: total annual amount can be limited.