Age 21 and Older
We pay for covered dental and dental-related services when they are:
- Within the scope of the eligible clients medical care program
- Medically necessary
- Within the standard of care; and
- Within accepted dental or medical practice procedures that are:
- Consistent with a diagnosis of dental disease or condition; and
- Reasonable in amount and duration of care, treatment, or service.
- Subject to the limitations and listings of non-covered procedures.
What oral health care services can adult clients not served by DDD?
Clients can see a dentist if they have pain or injury or possible infection to mouth teeth or jaw (including gums)
Under the above conditions, the dentist will always be paid to evaluate and diagnose.
Once a dentist determines what is wrong, he/she will determine what the treatment options are and whether or they qualify for the emergency oral healthcare benefit.
If the client elects to have care that does not qualify for the emergency oral healthcare benefit package, the client and dentist must work out payment arrangements. (See memo 10-86 for details)
Refer to the current Physician-Related Services/Healthcare Professional Services Billing Instructions, Section B, and memo 10-86 for more information regarding Emergency Oral Health Services- can this be in a box?
What can adults served by DDD receive?
Refer to the Billing Guide page 80.
Fee Schedule Links:
Current dental fee schedule (for CDTs)
Current physician fee schedule (for CPTs)
Billing Guide for Apple Health Clients.