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Medicaid reimbursement for Children’s Dental Services

 
Medicaid reimburses for children’s dental services rendered by licensed, Medicaid participating dentists. Medicaid reimbursable children’s dental services include:

•  Diagnostic examinations

•  Radiographs necessary to make a diagnosis

•  Preventive services

•  Restorations

•  Endodontics

•  Periodontal treatment

•  Dentures, complete and partial

•  Oral surgery

•  Orthodontic treatment

LIMITATIONS:

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 severely handicapping malocclusions or correction of a dental condition deterring physical development.  Prior authorization is required for all orthodontic services except the initial evaluation.

EXCEPTIONS:

The provider may request prior authorization for reimbursement for services in excess of the service limitations.  

ELIGIBILITY:

Medicaid reimburses for children’s dental services for all Medicaid recipients under the age of 21. 

REIMBURSEMENT:

Medicaid reimbursement for children’s dental services is the maximum Medicaid fee or the provider’s customary fee, whichever is lower.

For orthodontic treatment, an initial payment is made at the start of treatment, but regardless of the severity or duration of treatment, total payment may not exceed the fee for banding and 24 monthly adjustment visits.


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