Medicaid Benefits: Dental Services
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2018
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limits on Services | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 39, No - 6, NR - 6 | 2018 data limited to CN | Yes - 19 | Yes - 35 | Included in "Limits on Services" for 2018 | Not included in 2018 survey |
| Alabama | No | - | - | |||
| Alaska | Yes | CN | $3 | Must be prior authorized | - | - |
| Arizona | Yes | CN | No | $1000 limit for emergency dental services, $1000 comprehensive benefit for ALTCS members | - | - |
| Arkansas | Yes | CN | NR | NR | - | - |
| California | Yes | CN | $1 per outpatient dental visit | $1,800 soft cap on services/year, but does not apply to emergency services, maxillofacial surgery or to residents of nursing facilities, cap can be exceeded with prior authorization and medical necessity. | - | - |
| Colorado | Yes | CN | No | $1,000 maximum reimbursement covered per client, per year. Specific limitations apply depending on the dental procedure. | - | - |
| Connecticut | Yes | CN | No | Annual benefit maximum of $1000 unless medically necessary. Also excludes dental surgery, dentures and some dental treatment. One oral exam and prophylaxis per year or two per year for nursing facility residents; fixed bridges and implants not covered; coverage of partial dentures dependent on number of missing teeth. | - | - |
| Delaware | No | - | - | |||
| District of Columbia | Yes | CN | No | Some procedures require a PA | - | - |
| Florida | Yes | CN | No | Problem focused visits, extractions, pain management, and dentures are provided as medically necessary. | - | - |
| Georgia | Yes | CN | No | Limited to Emergency Dental visits. | - | - |
| Hawaii | Yes | CN | No | Emergency treatment shall include the following services: 1. Relief of dental pain; 2. Elimination of infections; and 3. Treatment of acute injuries to the teeth or supporting structures of the orofacial complex. | - | - |
| Idaho | Yes | CN | NR | No | - | - |
| Illinois | NR | NR | NR | NR | - | - |
| Indiana | Yes | CN | No | Prior authorization for specified services including non-emergency inpatient procedures and oral surgery. Exam and cleaning 1/year (2/year for nursing facility residents), frequency of x-rays limited by type, periodontia limited, second opinions required for specified procedures. | - | - |
| Iowa | NR | NR | NR | NR | - | - |
| Kansas | Yes | CN | $3.00 per service date | 1 exam and cleaning per 6 months; frequency of x-rays varies by type;1 crown per 5 years | - | - |
| Kentucky | Yes | CN | $3 | Comprehensive exam one per year per member per provider, x rays limited by type, prophylaxis limited by age, all other limited by age | - | - |
| Louisiana | Yes | CN | No | Limited to services listed below: Examination (in conjunction with denture construction) Radiographs (in conjunction with denture construction) Complete Dentures Denture relines Denture repairs Acrylic Partial Dentures (only in conjunction with opposing full denture) | - | - |
| Maine | Yes | CN | No | 2 exams with cleaning/year but only 1 in 150 days, 1 orthodontia treatment/lifetime | - | - |
| Maryland | No | - | - | |||
| Massachusetts | Yes | CN | No | No | - | - |
| Michigan | Yes | CN | $3/visit | Frequency limits on most services. Some services require PA. | - | - |
| Minnesota | Yes | CN | $3 copay for non-preventive office visits | Non-pregnant adults receive limited benefits. Exams and cleanings are limited to four times per year; the frequency of x-rays are limited by type. | - | - |
| Mississippi | Yes | CN | $3 per visit | $2500 max. per state fiscal year. | - | - |
| Missouri | Yes | CN | $.50 to $3 depending on cost | Traditional Medicaid Adults have dental coverage under a limited dental benefit package (CDT-code specific). | - | - |
| Montana | Yes | CN | Income at or below 100% FPL - $4 per visit; above FPL - 10% of payment amount | Annual services cap of $1,125 per benefit year; Aged, Blind, and Disabled category not subject to annual cap; Diagnostic, Preventive, and Anesthesia Services do not count toward the cap; crowns not covered | - | - |
| Nebraska | Yes | CN | $3 per specified service | Dental coverage is limited to $750 per fiscal year, excluding dental emergencies or extensive treatment circumstances | - | - |
| Nevada | NR | NR | NR | NR | - | - |
| New Hampshire | NR | NR | NR | NR | - | - |
| New Jersey | Yes | CN | Plan C and Plan D $5 copay per visit except for diagnostic and preventive services | No | - | - |
| New Mexico | Yes | CN | $7 for WDI recipients, on non-preventive services. | Most restorative services such as crowns are not covered for adults | - | - |
| New York | NR | NR | NR | NR | - | - |
| North Carolina | Yes | CN | $1 - $3 depending on the service | Yes - Not Specified | - | - |
| North Dakota | Yes | CN | $2 per visit | 1 exam/evaluation per year 1 panoramic radiographic image every 5 years 1 prophylaxis per year 2 topical applications of fluoride per year | - | - |
| Ohio | Yes | CN | Dental services are subject to copay of $3 per date of service per provider | Comprehensive adult dental coverage. Certain services require PA. | - | - |
| Oklahoma | Yes | CN | No | Emergency Extractions only | - | - |
| Oregon | Yes | CN | No | Dental services for adults include the prevention and amelioration of dental disease states, limits on denture, crown, and periodontal coverage. Pregnant women receive some additional services. | - | - |
| Pennsylvania | Yes | CN | Sliding scale based on the Medicaid fee for the service: $0.65 - $3.80 | Dental services provided by dentists are limited as follows: Dentures 1 per lifetime; Exams/prophylaxis 1 per 180 days; Crowns, Periodontics and Endodontics only via approved Benefit Limit Exception | - | - |
| Rhode Island | Yes | CN | No | Not all codes covered | - | - |
| South Carolina | NR | NR | NR | NR | - | - |
| South Dakota | Yes | CN | $3/procedure | $1,000 annual limit (emergency and preventive services and dentures are exempt from the $1,000 limit). | - | - |
| Tennessee | No | - | - | |||
| Texas | No | - | - | |||
| Utah | Yes | CN | No | Pregnant, Blind or Disabled adult Medicaid members are allowed dental services. All other Traditional members receive Emergency Dental Services only. | - | - |
| Vermont | Yes | CN | $3 per visit | $510 per year for non-pregnant or postpartum adults; limits on treatment for TMJ disorders and prophylaxis; prior authorization required for special procedures | - | - |
| Virginia | No | - | - | |||
| Washington | Yes | CN | No | Some may require Prior authorization | - | - |
| West Virginia | Yes | CN | No | Limited to emergent Services | - | - |
| Wisconsin | Yes | CN | $0.50 - $3, depending on the service. | Exam and cleaning limited to 1 per year, orthodontia not covered; a few services require prior approval | - | - |
| Wyoming | Yes | CN | No | Preventive and emergency services only. No restorative. | - | - |
2012
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 53 No - 3 | Yes - 22 No - 31 | ||||
| Alabama | No | NA | ||||
| Alaska | Yes | CN | No | Preventive and restorative services covered up to annual limit of $1,150 through an enhanced benefit, emergency treatment for relief of pain and infection not limited | Enhanced benefit services | Fee for service |
| American Samoa | Yes | See territory-specific FN | No | Dental services necessary for relief of pain and infection and for restoration of teeth and maintenance of dental health | ||
| Arizona | Yes | CN & MN | No | Limited to emergency treatment for relief of pain and infection and to services that could be provided by a physician | Fee for service | |
| Arkansas | Yes | CN & MN | No | $500 cap on services/year excluding extractions, adult exam and cleaning 1/year, frequency of x-rays limited by type, orthodontia not covered | Selected services | Fee for service |
| California | Yes | CN & MN | $1/visit | Coverage limited for non-pregnant or non-institutionalized adults to emergency treatment for relief of pain and infection plus federally required adult dental services unless service could be performed by a physician; $1,800 cap on services/year but cap doesn't apply to emergency services, maxillofacial surgery or to residents of nursing facilities; crowns not covered | Specified services including periodontal, crowns and root canals, pre-denture services, services for nursing facility residents | Fee for service |
| Colorado | Yes | CN | No | Limited to emergency treatment for relief of pain and infection and if related to specified concurrent medical conditions | Specified services | Fee for service |
| Connecticut | Yes | CN & MN | No | Periodontal and fixed bridges not covered, frequency of x-rays limited by type | Specified services | Fee for service |
| Delaware | No | NA | ||||
| District of Columbia | Yes | CN & MN | No | Adult exam and cleaning 2/year, frequency of x-rays limited by type, root canals limited to 2 molars/year | Services requiring inpatient hospitalization or general anesthesia | Fee for service |
| Florida | Yes | CN & MN | 5% of payment/procedure | Limited to services to alleviate pain or infection or preparatory or related to dentures | Fee for service | |
| Georgia | Yes | CN & MN | $.50-$3 for selected services depending on payment rate | Limited to emergency treatment for relief of pain and infection for non-pregnant adults, pregnant women receive additional services | Specified services, including oral surgery | Fee for service |
| Guam | Yes | CN | No | Limited to trauma care, treatment required due to medical conditions, and emergency treatment for relief of pain and infection | Fee for service using 40% of 2001 American Dental Association fee schedule | |
| Hawaii | Yes | CN & MN | No | Limited to emergency treatment for relief of pain, elimination of infection and treatment of acute injuries to teeth or supporting structures of the oro-facial complex | Fee for service | |
| Idaho | Yes | CN | No | Pregnant women and participants in HCBS waivers have full benefits, other adults are limited to emergency treatment for relief of pain and infection | Specified services | Fee for service for Enhanced Plan, capitated payment for Basic Plan |
| Illinois | Yes | CN & MN | No | Limited to emergency treatment for relief of pain and infection | Specified services | Fee for service through contracted intermediary |
| Indiana | Yes | CN | No | Exam and cleaning 1/year (2/year for nursing facility residents), frequency of x-rays limited by type, periodontia limited, second opinions required for specified procedures | Specified services including non-emergency inpatient procedures and oral surgery | Fee for service |
| Iowa | Yes | CN & MN | $3/day | Exam and cleaning 2/year, frequency of x-rays vary by type, orthodontia not covered | Specified services including crowns | Fee for service |
| Kansas | Yes | CN & MN | $3/date of service | Limited to emergency treatment for relief of pain and infection | Specified services | Fee for service |
| Kentucky | Yes | A, B & C - See state-specific FN | A - $2/visit | Adult exam and cleaning 1/year, frequency of x-rays limited by type, alveoplasty 1/quad/lifetime, coverage of gingevectomy limited by diagnosis | Specified services including periodontal scaling and root planing | Fee for service |
| Louisiana | Yes | CN | No | Exams and x-rays only covered in conjunction with denture construction | Yes | Fee for service |
| Maine | Yes | CN & MN | No | Limited to trauma care, diagnostic procedures and treatment for acute conditions, and emergency treatment for relief of pain and infection | Specified procedures | Fee for service |
| Maryland | Yes | CN & MN | No | Services for non-pregnant adults limited to trauma care and emergency treatment rendered in a hospital emergency department | Fee for service | |
| Massachusetts | Yes | CN & MN | No | Limited to diagnostic and preventive services, extractions, emergency visits and some oral surgery; limits do not apply to certain developmentally disabled adults | Specified services | Fee for service |
| Michigan | Yes | CN & MN | $3/visit | Adult exam and cleaning 2/year, frequency of x-rays limited by type | Fee for service, Public Dental Clinics paid average commercial rate | |
| Minnesota | Yes | A & B - See state-specific FN | No | Non-pregnant adults limited to exam and cleaning 1/year, frequency of x-rays limited by type | Specified services | Fee for service |
| Mississippi | Yes | CN | $3/visit | Limited to trauma care and emergency treatment for relief of pain and infection, maximum annual payments for specified services | Specified services | Fee for service |
| Missouri | Yes | CN | $.50-$3/service depending on payment | Adults who are not pregnant, blind or residing in nursing facilities are limited to trauma care related to facial injury or treatment of health-impacting disease or medical condition, orthodontia not covered | Specified services | Fee for service |
| Montana | Yes | A & B - See state-specific FN | $3/visit | A - exam and cleaning 2/year, frequency of x-rays limited by type, orthodontia not covered; B - services limited to emergency treatment for relief of pain and infection and to services essential for employment | Specified services including prosthetics, crowns and oral surgery | Fee for service |
| Nebraska | Yes | CN & MN | $3/specified services | Exam and cleaning 1/year, $1,000 maximum benefit/year included with denture services | Specified services including periodontia, crowns and root canals | Fee for service |
| Nevada | Yes | CN | No | Non-pregnant adults limited to trauma care and emergency treatment for relief of pain and infection, pregnant women also receive limited diagnostic and preventive care and limited periodontia | Most services | Fee for service |
| New Hampshire | Yes | CN & MN | No | Limited to trauma care and emergency treatment for relief of pain and infection | Fee for service | |
| New Jersey | Yes | CN & MN | No | Exam and cleaning 2/year, frequency of x-rays limited by type, orthodontia limited to specified medical conditions | Crowns, root canals and other specified services | Fee for service |
| New Mexico | Yes | CN | A - $0-$7/visit depending on income, B - $7/visit non-preventive services - see state-specific FN | Exam and cleaning 1/year, frequency of x-rays limited by type, specified limits on endodontic, periodontic and restorative services; A - benefit limited to emergency treatment for relief of pain and infection and includes oral surgery | Specified services | Fee for service |
| New York | Yes | CN & MN | No | 3 visits/year (limit applicable to dental clinics but not dental offices) | Specified services | Fee for service |
| North Carolina | Yes | CN & MN | $3/episode of treatment | Exam and cleaning 2/year; frequency of x-rays limited by type; root canals limited to anterior teeth; orthodontia, pulp caps, inlays and crowns not covered | Specified services including periodontal and orthodontic services and maxillofacial surgery | Fee for service, state-operated dental school providers settled to federal share of cost annually |
| North Dakota | Yes | CN & MN | $2/visit | Exam and cleaning 1/year, frequency of x-rays limited by type | Specified services | Fee for service |
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | No | Limited to treatment required for relief of pain and infection; oral surgery limited to emergencies | Specified services | |
| Ohio | Yes | CN | $3/date of service/provider | Exam and cleaning 1/year; frequency of x-rays limited by type | Specified services | Fee for service |
| Oklahoma | Yes | CN | No | Limited to emergency extractions and smoking cessation counseling only for non-pregnant adults, pregnant women have a limited benefit and persons residing in an ICF/MR have full benefits | Fee for service | |
| Oregon | Yes | A & B - See state-specific FN | A - $3/visit for restorative treatment only | A & B - services limited to funded conditions on the priority list B - limited to emergency treatment for pain and infection | Fee for service, using a percentage of commercial rates | |
| Pennsylvania | Yes | CN & MN | $.65-$3.80/service, depending on payment rate | CN: exam and cleaning 2/year; MN: preventive care not covered and medically necessary services limited to those provided in an inpatient, ambulatory surgery center (ASC) or short procedure unit (SPU) setting; CN & MN: crowns limited to 1/5 years for beneficiaries residing in a nursing facility or intermediate care facility; orthodontia not covered; services in outpatient hospital, ASC or SPU setting limited to $500 unless fee schedule rate for procedure is higher; services in inpatient hospital setting limited to $1,250 unless fee schedule rate for procedure is higher | Prosthetics, crowns, multiple or surgical extractions, periodontia and endodontia | Fee for service |
| Puerto Rico | Yes | CN & MN | $1/visit | Exam and cleaning 2/year, 1 comprehensive exam/year, frequency of x-rays varies by type | Service is included in the capitated rate paid to managed care plans | |
| Rhode Island | Yes | See state-specific FN | No | Orthodontia not covered | All services except emergency care and palliative treatment | Fee for service |
| South Carolina | No | |||||
| South Dakota | Yes | CN | $3/procedure | $1,000 annual limit on non-emergency services | Specified services | Fee for service, or percentage of charge for unlisted services |
| Tennessee | No | NA | ||||
| Texas | Yes | CN & MN | No | Adult coverage for other than ICF/MR residents limited to trauma | Specified surgical procedures | Fee for service, cost based supplemental payment to government providers |
| Utah | Yes | A, B & C - See state-specific FN | C - 10% of payment | A & B- Adult coverage limited to pregnant women and only for emergency dental services, C - limited to diagnostic and preventive services only with fillings and extractions | Specified services | Fee for service |
| Vermont | Yes | A - See state-specific FN | $3/visit | Exam and cleaning 2/year; endodontia limited to 3 teeth/lifetime; $495 annual limit for all services; crowns, bridges, orthodontia and periodontal not covered | Specified services | Fee for service |
| U.S. Virgin Islands | Yes | CN | No | Services in public health facilities only unless referral made to outside dentist | Root canals and crowns | Fee for service |
| Virginia | Yes | CN & MN | No | Limited to medically necessary oral surgery and associated diagnostic services, routine dental care not covered | Fee for service | |
| Washington | Yes | CN & MN | No | Preventive care including crowns, restorations, endodontia and periodontia available only for pregnant and post partum women and adults in institutions or participating in the state's HCBS programs; other adults limited to emergency treatment for trauma or the relief of pain and infection; adults awaiting transplants or joint replacement surgery also receive cleaning of teeth | Specified services | Fee for service |
| West Virginia | Yes | A, B & C | No | Limited to trauma care including maxillofacial surgery and to emergency treatment for relief of pain and infection | Fee for service using a percentage of fees established through the South Atlantic Regional Survey of Dental Fees | |
| Wisconsin | Yes | CN & MN | $.50-$3/service depending on payment | Exam and cleaning 1/year, frequency of x-rays limited by type, orthodontia not covered | Specified services | Fee for service |
| Wyoming | Yes | CN | No | Exam and cleaning 1/year, services limited to emergency treatment, x-rays and basic restorative procedures, including extractions | Fee for service |
2010
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 53 No - 3 | Yes - 22 No - 31 | ||||
| Alabama | No | NA | ||||
| Alaska | Yes | CN | No | Preventive and restorative services covered up to annual limit of $1,150 | Fee for service | |
| American Samoa | Yes | See territory-specific FN | No | |||
| Arizona | Yes | CN & MN | No | Limited to emergency treatment for relief of pain and infection and to services that could be provided by a physician | Fee for service | |
| Arkansas | Yes | CN & MN | No | $500 cap on services/year excluding extractions, adult exam and cleaning 1/year, frequency of x-rays limited by type, orthodontia not covered | Selected services | Fee for service |
| California | Yes | CN & MN | $1/visit | Coverage limited for non-pregnant or non-institutionalized adults to emergency treatment for relief of pain and infection plus federally required adult dental services unless service could be performed by a physician; $1,800 cap on services/year but cap doesn't apply to emergency services, maxillofacial surgery or to residents of nursing facilities; crowns not covered | Specified services including periodontal, crowns and root canals, pre-denture services, services for nursing facility residents | Fee for service |
| Colorado | Yes | CN | No | Limited to emergency treatment for relief of pain and infection and if related to specified concurrent medical conditions | Specified services | Fee for service |
| Connecticut | Yes | CN & MN | No | Periodontal and fixed bridges not covered, frequency of x-rays limited by type | Specified services | Fee for service |
| Delaware | No | NA | ||||
| District of Columbia | Yes | CN & MN | No | Fee for service | ||
| Florida | Yes | CN & MN | 5% of payment for denture-related services | Limited to services to alleviate pain or infection or preparatory or related to dentures | Fee for service | |
| Georgia | Yes | CN & MN | No | Limited to emergency treatment for relief of pain and infection, limit does not apply to pregnant women | Specified services | Fee for service |
| Guam | Yes | CN | No | Limited to trauma care, treatment required due to medical conditions, and emergency treatment for relief of pain and infection | Fee for service | |
| Hawaii | Yes | CN & MN | No | Limited to emergency treatment for relief of pain, elimination of infection and treatment of acute injuries to teeth or supporting structures of the oro-facial complex | Fee for service | |
| Idaho | Yes | CN | No | Limited to preventive and restorative services | Specified services | Fee for service for Enhanced Plan, capitated payment for Basic Plan |
| Illinois | Yes | CN & MN | No | Periodontia, posterior root canals and preventive services including exams and cleanings not covered; coverage limited to exams and x-rays necessary to assess oral health, to diagnose oral problems and to develop a treatment plan | Specified services | Fee for service through contracted intermediary |
| Indiana | Yes | CN | No | $600 maximum benefit/year included with denture services, exam and cleaning 1/year (2/year for nursing facility residents), frequency of x-rays limited by type, periodontia limited, second opinions required for specified procedures | Specified services including non-emergency inpatient procedures and oral surgery | Fee for service |
| Iowa | Yes | CN & MN | $3/day | Exam and cleaning 2/year, frequency of x-rays vary by type | Specified services including crowns | Fee for service |
| Kansas | Yes | CN & MN | $3/date of service | Limited to emergency treatment for relief of pain and infection | Specified services | Fee for service |
| Kentucky | Yes | A, B & C - See state-specific FN | A - $2/visit | Adult exam and cleaning 1/year, frequency of x-rays limited by type, alveoplasty 1/quad/lifetime, coverage of gingevectomy limited by diagnosis | Specified services including periodontal scaling and root planing | Fee for service |
| Louisiana | Yes | CN & MN - See state-specific FN | No | Exams and x-rays only covered in conjunction with denture construction; pregnant women may also receive specified preventive, restorative and periodontal services | Specified services | Fee for service |
| Maine | Yes | CN & MN | No | Limited to trauma care, diagnostic procedures and treatment for acute conditions, and emergency treatment for relief of pain and infection | Specified procedures | Fee for service |
| Maryland | Yes | CN & MN | No | Services for non-pregnant adults limited to trauma care and emergency treatment rendered in a hospital emergency department | Fee for service | |
| Massachusetts | Yes | CN & MN | No | Limited to diagnostic and preventive services, extractions, emergency visits and some oral surgery; limits do not apply to certain developmentally disabled adults | Specified services | Fee for service |
| Michigan | Yes | CN & MN | $3/visit | Adult exam and cleaning 2/year, frequency of x-rays limited by type | Fee for service, Public Dental Clinics paid average commercial rate | |
| Minnesota | Yes | A & B - See state-specific FN | No | Non-pregnant adults limited to exam and cleaning 1/year, frequency of x-rays limited by type | Specified services | Fee for service |
| Mississippi | Yes | CN | $3/visit | Limited to trauma care and emergency treatment for relief of pain and infection, maximum annual payments for specified services | Specified services | Fee for service |
| Missouri | Yes | CN | $.50-$3/ service depending on payment | Adults who are not pregnant, blind or residing in nursing facilities are limited to trauma care related to facial injury or treatment of health-impacting disease or medical condition | Specified services | Fee for service |
| Montana | Yes | A & B - See state-specific FN | $3/visit | A - exam and cleaning 2/year, frequency of x-rays limited by type, B - services limited to emergency treatment for relief of pain and infection and to services essential for employment | Specified services including prosthetics, crowns and oral surgery | Fee for service |
| Nebraska | Yes | CN & MN | $3/specified services | Exam and cleaning 1/year, $1,000 maximum benefit/year included with denture services | Specified services including periodontia, crowns and root canals | Fee for service |
| Nevada | Yes | CN | No | Limited to trauma care and emergency treatment for relief of pain and infection, periodontia covered for pregnant women | All non-emergency services | Fee for service |
| New Hampshire | Yes | CN & MN | No | Limited to trauma care and emergency treatment for relief of pain and infection | Fee for service | |
| New Jersey | Yes | CN & MN | No | Exam and cleaning 2/year, frequency of x-rays limited by type | Crowns, root canals and other specified services | Fee for service |
| New Mexico | Yes | CN | A - $0-$7/visit depending on income, B - $7/visit non-preventive services - see state-specific FN | Exam and cleaning 1/year, frequency of x-rays limited by type, specified limits on endodontic, periodontic and restorative services; A - benefit limited to emergency treatment for relief of pain and infection and includes oral surgery | Specified services | Fee for service |
| New York | Yes | CN & MN | No | 3 visits/year (limit applicable to dental clinics but not dental offices) | Specified services | Fee for service |
| North Carolina | Yes | CN & MN | $3/episode of treatment | Exam and cleaning 2/year; frequency of x-rays limited by type; root canals limited to anterior teeth; pulp caps, inlays, implants, bridges and crowns not covered | Specified services including periodontal and orthodontic services and maxillofacial surgery | Fee for service |
| North Dakota | Yes | CN & MN | $2/visit | Exam and cleaning 1/year, frequency of x-rays limited by type | Specified services | Fee for service |
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | No | Specified services | ||
| Ohio | Yes | CN | $3/date of service/provider | Exam and cleaning 1/year; frequency of x-rays limited by type | Specified services | Fee for service |
| Oklahoma | Yes | CN | No | Limited to emergency extractions and smoking cessation counseling only for non-pregnant adults | Fee for service | |
| Oregon | Yes | A & B - See state-specific FN | A - $3/visit for restorative treatment only | A & B - services limited to funded conditions on the priority list B - limited to emergency treatment for pain and infection | Fee for service, using a percentage of commercial rates | |
| Pennsylvania | Yes | CN & MN | $.50-$3/service, depending on payment rate | CN: exam and cleaning 2/year, MN: preventive care not covered and medically necessary services limited to those provided in a hospital or amb surgery center setting, CN & MN: crowns limited to 1/5 years, services in outpatient hospital or amb surgery center setting limited to $500/procedure unless fee screen higher, services in inpatient hospital setting limited to $1,250/procedure unless fee screen higher | Prosthetics, crowns, multiple or surgical extractions, periodontia and endodontia | Fee for service |
| Puerto Rico | Yes | CN & MN | $1/visit | Exam and cleaning 2/year, 1 comprehensive exam/year, frequency of x-rays varies by type | Service is included in the capitated rate paid to managed care plans | |
| Rhode Island | Yes | See state-specific FN | No | Orthodontia not covered | All services except emergency care and palliative treatment | Fee for service |
| South Carolina | Yes | CN | $3/visit | Services must be authorized by dental contractor | Fee for service | |
| South Dakota | Yes | CN | $3/procedure | Specified services | Fee for service, or percentage of charge for unlisted services | |
| Tennessee | No | NA | ||||
| Texas | Yes | CN & MN | No | Adult coverage for other than ICF/MR residents limited to trauma or cancer-related care | Specified surgical procedures | Fee for service |
| Utah | Yes | A & C - See state-specific FN | C - 10% of payment | A - Adult coverage limited to pregnant women and only for x-rays, fillings, extractions and root canals, C - limited to diagnostic and preventive services only with fillings and extractions | Specified services | Fee for service |
| Vermont | Yes | A - See state-specific FN | $3/visit | Exam and cleaning 2/year; endodontia limited to 3 teeth/lifetime; $495 annual limit for all services; crowns, bridges, orthodontia and periodontal not covered | Specified services | Fee for service |
| U.S. Virgin Islands | Yes | CN | No | Services in public health facilities only unless referral made to outside dentist | Root canals and crowns | Fee for service |
| Virginia | Yes | CN & MN | No | Limited to medically necessary oral surgery and associated diagnostic services | Fee for service | |
| Washington | Yes | CN & MN | No | Specified restorative services, including crowns and anterior root canals, not covered for adults; palliative emergent treatment and deep conscious sedation covered only for intellectually disabled adults | Specified services | Fee for service |
| West Virginia | Yes | A, B & C | No | Limited to trauma care including maxillofacial surgery and to emergency treatment for relief of pain and infection | Fee for service using a percentage of fees established through the South Atlantic Regional Survey of Dental Fees | |
| Wisconsin | Yes | CN & MN | $.50-$3/service depending on payment | Exam and cleaning 1/year, frequency of x-rays limited by type, orthodontia not covered | Specified services | Fee for service |
| Wyoming | Yes | CN | No | Exam and cleaning 1/year, 2 emergency treatments/year, frequency of x-rays limited by type, crowns not covered | Fee for service |
2008
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 51 No - 5 | Yes - 21 No - 30 | ||||
| Alabama | No | NA | ||||
| Alaska | Yes | CN | No | Preventive and restorative services covered up to annual limit of $1,150 | Fee for service | |
| American Samoa | Yes | See territory-specific FN | No | |||
| Arizona | Yes | CN & MN | No | Limited to emergency treatment for relief of pain and infection | Fee for service | |
| Arkansas | No | NA | ||||
| California | Yes | CN & MN | $1/visit | $1,800 cap on services/year but cap doesn't apply to emergency services, maxillofacial surgery or to residents of nursing facilities; crowns not covered | Specified services including periodontal, crowns and root canals, pre-denture services, services for nursing facility residents | Fee for service |
| Colorado | No | NA | ||||
| Connecticut | Yes | CN & MN | No | Periodontal and fixed bridges not covered, frequency of x-rays limited by type | Specified services | Fee for service |
| Delaware | No | NA | ||||
| District of Columbia | Yes | CN & MN | No | Fee for service | ||
| Florida | Yes | CN & MN | 5% of payment for denture-related services | Limited to services to alleviate pain or infection or preparatory or related to dentures | Fee for service | |
| Georgia | Yes | CN & MN | No | Limited to emergency treatment for relief of pain and infection, limit does not apply to pregnant women | Specified services | Fee for service |
| Guam | Yes | CN | No | Limited to trauma care, treatment required due to medical conditions, and emergency treatment for relief of pain and infection | Fee for service | |
| Hawaii | Yes | CN & MN | No | Preventive and restorative services up to $500/year | Fee for service | |
| Idaho | Yes | CN | No | Limited to preventive and restorative services | Specified services | Fee for service for Enhanced Plan, capitated payment for Basic Plan |
| Illinois | Yes | CN & MN | No | Periodontia, posterior root canals and preventive services including exams and cleanings not covered; coverage limited to exams and x-rays necessary to assess oral health, to diagnose oral problems and to develop a treatment plan | Specified services | Fee for service through contracted intermediary |
| Indiana | Yes | CN | No | $600 maximum benefit/year included with denture services, exam and cleaning 1/year (2/year for nursing facility residents), frequency of x-rays limited by type, periodontia limited, second opinions required for specified procedures | Specified services including non-emergency inpatient procedures and oral surgery | Fee for service |
| Iowa | Yes | CN & MN | $3/day | Exam and cleaning 2/year, frequency of x-rays vary by type, orthodontia and periodontia not covered, endodontia limited to root canals for anterior teeth with crowns if necessary | Specified services including crowns | Fee for service |
| Kansas | Yes | CN & MN | $3/date of service | Limited to emergency treatment for relief of pain and infection | Specified services | Fee for service |
| Kentucky | Yes | A, B & C - See state-specific FN | A - $2/visit | Adult exam and cleaning 1/year, frequency of x-rays limited by type, alveoplasty 1/quad/lifetime, coverage of gingevectomy limited by diagnosis | Specified services including periodontal scaling and root planing | Fee for service |
| Louisiana | Yes | CN & MN - See state-specific FN | No | Exams and x-rays only covered in conjunction with denture construction; pregnant women may also receive specified preventive, restorative and periodontal services | Specified services | Fee for service |
| Maine | Yes | CN & MN | No | Limited to trauma care, diagnostic procedures for acute conditions, and emergency treatment for relief of pain and infection | Specified procedures | Fee for service |
| Maryland | Yes | CN & MN | No | Services for non-pregnant adults limited to trauma care and emergency treatment rendered in a hospital emergency department | Fee for service | |
| Massachusetts | Yes | CN & MN | No | Adult exam and cleaning 2/year, root canals limited to anterior teeth | Specified services | Fee for service |
| Michigan | Yes | CN & MN | $3/visit | Adult exam and cleaning 2/year, frequency of x-rays limited by type | Fee for service, Public Dental Clinics paid average commercial rate | |
| Minnesota | Yes | A & B - See state-specific FN | No | Specified services | Fee for service | |
| Mississippi | Yes | CN | $3/visit | Limited to trauma care and emergency treatment for relief of pain and infection, maximum annual payments for specified services | Specified services | Fee for service |
| Missouri | Yes | CN | $.50-$3/ service depending on payment | Exam and cleaning 2/year except adults who are not pregnant, blind or residing in nursing facilities are limited to trauma care related to facial injury or treatment of health-impacting disease or medical condition | Specified services | Fee for service |
| Montana | Yes | A & B - See state-specific FN | $3/visit | A - Exam and cleaning 2/year, frequency of x-rays limited by type, bridges limited to anterior teeth and crowns to posterior teeth B - Services limited to emergency treatment for relief of pain and infection and to services essential for employment | Specified services including prosthetics and oral surgery | Fee for service |
| Nebraska | Yes | CN & MN | $3/specified services | Exam and cleaning 1/year, $1,000 maximum benefit/year included with denture services | Specified services including periodontia, crowns and root canals | Fee for service |
| Nevada | Yes | CN | No | Limited to trauma care and emergency treatment for relief of pain and infection, periodontia covered for pregnant women | Fee for service | |
| New Hampshire | Yes | CN & MN | No | Limited to trauma care and emergency treatment for relief of pain and infection | Fee for service | |
| New Jersey | Yes | CN & MN | No | Exam and cleaning 2/year, frequency of x-rays limited by type | Crowns, root canals and other specified services | Fee for service |
| New Mexico | Yes | CN | A - $5/visit, B - $7/visit non-preventive services - see state-specific FN | Exam and cleaning 1/year, frequency of x-rays limited by type, specified limits on endodontic, periodontic and restorative services | Specified services | Fee for service |
| New York | Yes | CN & MN | No | 3 visits/year (limit applicable to dental clinics but not dental offices) | Specified services | Fee for service |
| North Carolina | Yes | CN & MN | $3/episode of treatment | Exam and cleaning 2/year, frequency of x-rays limited by type, root canals limited to anterior teeth, pulp caps, inlays, implants, bridges and crowns not covered | Specified services including periodontal and orthodontic services and maxillofacial surgery | Fee for service |
| North Dakota | Yes | CN & MN | $2/visit | Specified services | Fee for service | |
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | No | Specified services | ||
| Ohio | Yes | CN | $3/date of service/provider | Exam and cleaning 1/year; frequency of x-rays limited by type | Specified services | Fee for service |
| Oklahoma | Yes | CN | No | Limited to emergency extractions and smoking cessation counseling only for non-pregnant adults | Fee for service | |
| Oregon | Yes | A & B - See state-specific FN | A - $3/visit except diagnostic tests and routine exam/cleaning | B - limited to emergency treatment for pain and infection | Fee for service | |
| Pennsylvania | Yes | CN & MN | $.50-$3/service, depending on payment rate | CN: exam and cleaning 2/year, MN: preventive care not covered and medically necessary services limited to those provided in a hospital or ambulatory surgery center setting, CN & MN: crowns limited to 1/5 years, services in outpatient hospital or ambulatory surgery center setting limited to $500/procedure unless fee screen higher, services in inpatient hospital setting limited to $1,000/procedure unless fee screen higher | Prosthetics, crowns, multiple or surgical extractions, periodontia and endodontia | Fee for service |
| Puerto Rico | Yes | CN & MN | No | Exam and cleaning 2/year, 1 comprehensive exam/year | Fee for service | |
| Rhode Island | Yes | CN & MN - see state-specific FN | No | Orthodontia not covered | All services except emergency care and palliative treatment | Fee for service |
| South Carolina | Yes | CN | $3/visit | Limited to trauma care and emergency treatment for relief of pain and infection | Fee for service | |
| South Dakota | Yes | CN | $3/procedure | Specified services | Fee for service, or percentage of charge for unlisted services | |
| Tennessee | No | NA | ||||
| Texas | Yes | CN & MN | No | Adult coverage for other than ICF/MR residents limited to trauma or cancer-related care | Specified surgical procedures | Fee for service |
| Utah | Yes | A & C - See state-specific FN | C - 10% of payment | A - Adult coverage limited to pregnant women and only for x-rays, fillings, extractions and root canals, C - limited to diagnostic and preventive services only with fillings and extractions | Specified services | Fee for service |
| Vermont | Yes | A - See state-specific FN | $3/visit | Exam and cleaning 2/year, endodontia limited to 3 teeth/lifetime, annual payment limit $495 for all services; crowns, bridges, orthodontia and periodontal not covered | Fee for service | |
| U.S. Virgin Islands | Yes | CN | No | Services in public health facilities only unless referral made to outside dentist | Root canals and crowns | Fee for service |
| Virginia | Yes | CN & MN | No | Limited to medically necessary oral surgery and associated diagnostic services | Fee for service | |
| Washington | Yes | CN & MN | No | Specified restorative services, including crowns and anterior root canals, not covered for adults | Specified services | Fee for service |
| West Virginia | Yes | A, B & C | No | Limited to trauma care including maxillofacial surgery and to emergency treatment for relief of pain and infection | Fee for service using a percentage of fees established through the South Atlantic Regional Survey of Dental Fees | |
| Wisconsin | Yes | CN & MN | $.50-$3/service depending on payment | Exam and cleaning 1/year, frequency of x-rays limited by type, orthodontia not covered | Specified services | Fee for service |
| Wyoming | Yes | CN | No | Exam and cleaning 1/year, 2 emergency treatments/year, frequency of x-rays limited by type, crowns not covered | Fee for service |
2006
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 51 No - 5 | Yes - 22 No - 29 | ||||
| Alabama | No | NA | ||||
| Alaska | Yes | CN | No | Limited to emergency treatment for relief of pain and infection | Fee for service | |
| American Samoa | Yes | See territory-specific FN | No | |||
| Arizona | Yes | CN & MN | No | Limited to emergency treatment for relief of pain and infection | Fee for service | |
| Arkansas | No | NA | ||||
| California | Yes | CN & MN | $1/visit | $1,800 cap on services/year but cap doesn't apply to emergency services, maxillofacial surgery or to residents of nursing facilities; crowns not covered | Specified services including periodontal, crowns and root canals, pre-denture services, services for nursing facility residents | Fee for service |
| Colorado | No | NA | ||||
| Connecticut | Yes | CN & MN | No | Periodontal and fixed bridges not covered, frequency of x-rays limited by type | Specified services | Fee for service |
| Delaware | No | NA | ||||
| District of Columbia | Yes | CN & MN | No | Fee for service | ||
| Florida | Yes | CN & MN | 5% of payment for denture-related services | Limited to services to alleviate pain or infection or preparatory or related to dentures | Fee for service | |
| Georgia | Yes | CN & MN | No | Limited to emergency treatment for relief of pain and infection, limit does not apply to pregnant women | Specified services | Fee for service |
| Guam | Yes | CN | No | Limited to trauma care, treatment required due to medical conditions, and emergency treatment for relief of pain and infection | Fee for service | |
| Hawaii | Yes | CN & MN | No | Limited to emergency treatment for relief of pain, infection and bleeding | Fee for service | |
| Idaho | Yes | CN | No | Limited to preventative and restorative services | Fee for service | |
| Illinois | Yes | CN & MN | No | Periodontia, posterior root canals and preventive services including exams and cleanings not covered; coverage limited to exams and x-rays necessary to assess oral health, to diagnose oral problems and to develop a treatment plan | Specified services | Fee for service through contracted intermediary |
| Indiana | Yes | CN | No | $600 maximum benefit/year included with denture services, exam and cleaning 1/year (2/year for nursing facility residents), frequency of x-rays limited by type, periodontia limited, second opinions required for specified procedures | Specified services including non-emergency inpatient procedures and oral surgery | Fee for service |
| Iowa | Yes | CN & MN | $3/day | Exam and cleaning 2/year, frequency of x-rays vary by type, orthodontia and periodontia not covered, endodontia limited to root canals for anterior teeth with crowns if necessary | Specified services including crowns | Fee for service |
| Kansas | Yes | CN & MN | $3/date of service | Limited to emergency treatment for relief of pain and infection | Specified services | Fee for service |
| Kentucky | Yes | A, B & C - See state-specific FN | A - $2/visit | Adult exam and cleaning 1/year, frequency of x-rays limited by type, alveoplasty 1/quad/lifetime, coverage of gingevectomy limited by diagnosis | Specified services including periodontal scaling and root planing | Fee for service |
| Louisiana | Yes | CN & MN - See state-specific FN | No | Exams and x-rays only covered in conjunction with denture construction; pregnant women may also receive specified preventive, restorative and periodontal services | Specified services | Fee for service |
| Maine | Yes | CN & MN | No | Limited to trauma care, diagnostic procedures for acute conditions, and emergency treatment for relief of pain and infection | Specified procedures | Fee for service |
| Maryland | Yes | CN & MN | No | Services for non-pregnant adults limited to trauma care and emergency treatment rendered in a hospital emergency department | Fee for service | |
| Massachusetts | Yes | CN & MN | No | Adult exam and cleaning 2/year, root canals limited to anterior teeth | Specified services | Fee for service |
| Michigan | Yes | CN & MN | $3/visit | Adult exam and cleaning 2/year, frequency of x-rays limited by type | Fee for service, Public Dental Clinics paid average commercial rate | |
| Minnesota | Yes | A & B - See state-specific FN | B1 - 50% of payment for restorative services - See state-specific FN | A - includes limited orthodontia coverage | Specified services | Fee for service |
| Mississippi | Yes | CN | $3/visit | Limited to trauma care and emergency treatment for relief of pain and infection, maximum annual payments for specified services | Specified services | Fee for service |
| Missouri | Yes | CN | $.50-$3/ service depending on payment | Exam and cleaning 2/year except adults who are not pregnant, blind or residing in nursing facilities are limited to trauma care related to facial injury or treatment of health-impacting disease or medical condition | Specified services | Fee for service |
| Montana | Yes | A & B - See state-specific FN | $3/visit | A - Exam and cleaning 2/year, frequency of x-rays limited by type, bridges limited to anterior teeth and crowns to posterior teeth B - Services limited to emergency treatment for relief of pain and infection and to services essential for employment | Specified services including prosthetics and oral surgery | Fee for service |
| Nebraska | Yes | CN & MN | $3/specified services | Exam and cleaning 1/year | Specified services including periodontia, crowns and root canals | Fee for service |
| Nevada | Yes | CN | No | Limited to trauma care and emergency treatment for relief of pain and infection | Fee for service | |
| New Hampshire | Yes | CN & MN | No | Limited to trauma care and emergency treatment for relief of pain and infection | Specified services | Fee for service |
| New Jersey | Yes | CN & MN | No | Exam and cleaning 2/year, frequency of x-rays limited by type | Specified services | Fee for service |
| New Mexico | Yes | CN | A - $5/visit, B - $7/visit non-preventive services - see state-specific FN | Exam and cleaning 1/year, frequency of x-rays limited by type, specified limits on endodontic, periodontic and restorative services | Specified services | Fee for service |
| New York | Yes | CN & MN | No | 3 visits/year (limit applicable to dental clinics but not dental offices) | Specified services | Fee for service |
| North Carolina | Yes | CN & MN | $3/episode of treatment | Exam and cleaning 2/year, frequency of x-rays limited by type, root canals limited to anterior teeth, prefabricated crowns and pulpotomies limited to 6/day, pulp caps and recement inlays and crowns not covered | Specified services including periodontal and orthodontic services and maxillofacial surgery | Fee for service |
| North Dakota | Yes | CN & MN | $2/visit | Specified services | Fee for service | |
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | No | Specified services | ||
| Ohio | Yes | CN | $3/day | Exam and cleaning 1/year; frequency of x-rays limited by type; crowns, posts and related services not covered | Specified services | Fee for service |
| Oklahoma | Yes | CN | No | Limited to emergency extractions and smoking cessation counseling only for non-pregnant adults | Fee for service | |
| Oregon | Yes | A & B - See state-specific FN | A - $3/visit except diagnostic tests and routine exam/cleaning | B - limited to emergency treatment for pain and infection | Fee for service | |
| Pennsylvania | Yes | CN & MN | $.50-$3/service, depending on payment | CN: exam and cleaning 2/year, MN: preventive care not covered and medically necessary services limited to those provided in a hospital or ambulatory surgery center setting, CN & MN: crowns limited to 1/5 years, services in outpatient hospital or ambulatory surgery center setting limited to $500/procedure unless fee screen higher, services in inpatient hospital setting limited to $1,000/procedure unless fee screen higher | Prosthetics, crowns, multiple or surgical extractions, periodontia and endodontia | Fee for service |
| Puerto Rico | Yes | CN & MN | No | Exam and cleaning 2/year, 1 comprehensive exam/year | Fee for service | |
| Rhode Island | Yes | CN & MN - see state-specific FN | No | Orthodontia not covered | All services except emergency care and palliative treatment | Fee for service |
| South Carolina | Yes | CN | $3/visit | Limited to trauma care and emergency treatment for relief of pain and infection | Fee for service | |
| South Dakota | Yes | CN | $3/procedure | Specified services | Fee for service, or percentage of charge for unlisted services | |
| Tennessee | No | NA | ||||
| Texas | Yes | CN & MN | No | Adult coverage for other than ICF/MR residents limited to trauma or cancer-related care | Specified surgical procedures | Fee for service |
| Utah | Yes | A & C - See state-specific FN | C - 10% of payment | A - limited to x-rays, fillings, extractions and root canals, C - limited to diagnostic and preventive services only with fillings and extractions | Specified services | Fee for service |
| Vermont | Yes | A - See state-specific FN | $3/visit | Exam and cleaning 2/year, endodontia limited to 3 teeth/lifetime, annual payment limit $495 for all services; crowns, bridges, orthodontia and periodontal not covered | Fee for service | |
| U.S. Virgin Islands | Yes | CN | No | Services in public health facilities only unless referral made to outside dentist | Root canals and crowns | Fee for service |
| Virginia | Yes | CN & MN | No | Limited to trauma care and oral surgery | Fee for service | |
| Washington | Yes | CN & MN | No | Specified restorative services, including crowns and anterior root canals, not covered for adults | Specified services | Fee for service |
| West Virginia | Yes | CN & MN | No | Limited to trauma care including maxillofacial surgery and to emergency treatment for relief of pain and infection | Fee for service using a percentage of fees established through the South Atlantic Regional Survey of Dental Fees | |
| Wisconsin | Yes | CN & MN | $.50-$3/service depending on payment | Exam and cleaning 1/year, frequency of x-rays limited by type, orthodontia not covered | Specified services | Fee for service |
| Wyoming | Yes | CN | No | Exam and cleaning 1/year, 2 emergency treatments/year, frequency of x-rays limited by type, crowns not covered | Fee for service |
2004
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 50 No - 6 | Yes - 20 No - 30 | ||||
| Alabama | No | NA | ||||
| Alaska | Yes | CN | No | Limited to emergency treatment for relief of pain and infection | Fee for service | |
| American Samoa | Yes | See territory-specific FN | No | |||
| Arizona | Yes | CN & MN | No | Limited to emergency treatment for relief of pain and infection | Fee for service | |
| Arkansas | No | NA | ||||
| California | Yes | CN & MN | $1/visit | Crowns not covered | Specified services including periodontal, crowns and root canals, pre-denture services, services for nursing facility residents | Fee for service |
| Colorado | No | NA | ||||
| Connecticut | Yes | CN & MN | No | Periodontal and fixed bridges not covered, frequency of x-rays limited by type | Specified services | Fee for service |
| Delaware | No | NA | ||||
| District of Columbia | No | NA | ||||
| Florida | No | NA | ||||
| Georgia | Yes | CN & MN | No | Limited to emergency treatment for relief of pain and infection, $600/year limit | Specified services | Fee for service |
| Guam | Yes | CN | No | Limited to trauma care, treatment required due to medical conditions, and emergency treatment for relief of pain and infection | Fee for service | |
| Hawaii | Yes | CN & MN | No | Limited to emergency treatment for relief of pain, infection and bleeding | Fee for service | |
| Idaho | Yes | CN | No | Limited to preventative and restorative services | Fee for service | |
| Illinois | Yes | CN & MN | No | Periodontia, posterior root canals and preventive services including exams and cleanings not covered; coverage limited to exams and x-rays necessary to assess oral health, to diagnose oral problems and to develop a treatment plan | Specified services | Fee for service through contracted intermediary |
| Indiana | Yes | CN | No | $600 maximum benefit/year included with denture services, exam and cleaning 1/year (2/year for nursing facility residents), frequency of x-rays limited by type, periodontia limited, second opinions required for specified procedures | Specified services including non-emergency inpatient procedures and oral surgery | Fee for service |
| Iowa | Yes | CN & MN | $3/day | Exam and cleaning 2/year, frequency of x-rays vary by type, orthodontia and periodontia not covered, endodontia limited to root canals for anterior teeth with crowns if necessary | Specified services including periodontal | Fee for service |
| Kansas | Yes | CN & MN | $3/date of service | Limited to emergency treatment for relief of pain and infection | Specified services | Fee for service |
| Kentucky | Yes | CN & MN | $2/visit | Exam and cleaning 1/year, frequency of x-rays limited by type, alveoplasty 1/quad/lifetime, coverage of gingevectomy limited by diagnosis | Specified services including periodontal scaling and root planing | Fee for service |
| Louisiana | Yes | CN & MN - See state-specific FN | No | Exams and x-rays only covered in conjunction with denture construction; pregnant women may also receive specified preventive, restorative and periodontal services | Specified services | Fee for service |
| Maine | Yes | CN & MN | No | Limited to trauma care, diagnostic procedures for acute conditions, and emergency treatment for relief of pain and infection | Oral cancer treatment | Fee for service |
| Maryland | Yes | CN & MN | No | Services for non-pregnant adults limited to trauma care and emergency treatment rendered in a hospital emergency department | Fee for service | |
| Massachusetts | Yes | CN & MN | No | Limited to emergency care services including x-rays, extractions and oral surgery unless beneficiary meets specified criteria related to severe, chronic disability resulting in inability to maintain oral hygiene or to clinical condition where infection resulting from oral disease would be life threatening | Specified services | Fee for service |
| Michigan | Yes | CN & MN | $3/visit | Limited to emergency treatment for relief of pain and infection | Fee for service | |
| Minnesota | Yes | A & B - See state-specific FN | B1 - 50% of payment for restorative services - See state-specific FN | A - includes limited orthodontia coverage | Specified services | Fee for service |
| Mississippi | Yes | CN | $3/visit | Limited to trauma care and emergency treatment for relief of pain and infection, maximum annual payments for specified services | Specified services | Fee for service |
| Missouri | Yes | CN | $.50-$3/ service depending on payment | Exam and cleaning 2/year | Specified services | Fee for service |
| Montana | Yes | A & B - See state-specific FN | $3/visit | A - Exam and cleaning 2/year, frequency of x-rays limited by type, bridges limited to anterior teeth and crowns to posterior teeth B - Services limited to emergency treatment for relief of pain and infection and to services essential for employment | Specified services including prosthetics and oral surgery | Fee for service |
| Nebraska | Yes | CN & MN | $3/specified services | Exam and cleaning 1/year | Specified services including periodontia, crowns and root canals | Fee for service |
| Nevada | Yes | CN | No | Limited to trauma care and emergency treatment for relief of pain and infection | Fee for service | |
| New Hampshire | Yes | CN & MN | No | Limited to trauma care and emergency treatment for relief of pain and infection | Specified services | Fee for service |
| New Jersey | Yes | CN & MN | No | Exam and cleaning 2/year, frequency of x-rays limited by type | Specified services | Fee for service |
| New Mexico | Yes | CN | B - $7/visit non-preventive services - see state-specific FN | 1 exam and cleaning/year, frequency of x-rays limited by type, specified limits on endodontic, periodontic and restorative services | Specified services | Fee for service |
| New York | Yes | CN & MN | No | 3 visits/year (limit applicable to dental clinics but not dental offices) | Specified services | Fee for service |
| North Carolina | Yes | CN & MN | $3/episode of treatment | Exam and cleaning 2/year, frequency of x-rays limited by type, root canals limited to anterior teeth, prefabricated crowns and pulpotomies limited to 6/day, pulp caps and recement inlays and crowns not covered | Specified services including periodontal and orthodontic services and maxillofacial surgery | Fee for service |
| North Dakota | Yes | CN & MN | $2/visit | Specified services | Fee for service | |
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | No | Specified services | ||
| Ohio | Yes | CN | No | Specified services | Fee for service | |
| Oklahoma | Yes | CN | No | Limited to emergency extractions and smoking cessation counseling | Fee for service | |
| Oregon | Yes | A & B - See state-specific FN | A - $3/visit except diagnostic tests and routine exam/cleaning | B - limited to emergency treatment for pain and infection | Fee for service | |
| Pennsylvania | Yes | CN & MN | No | CN: exam and cleaning 2/year, MN: preventive care not covered and medically necessary services limited to those provided in a hospital or ambulatory surgery center setting, CN & MN: crowns limited to 1/5 years, services in outpatient hospital or ambulatory surgery center setting limited to $500/procedure unless fee screen higher, services in inpatient hospital setting limited to $1,000/procedure unless fee screen higher | Prosthetics, crowns, multiple or surgical extractions, periodontia and endodontia | Fee for service |
| Puerto Rico | Yes | CN & MN | No | Exam and cleaning 2/year, 1 comprehensive exam/year | Fee for service | |
| Rhode Island | Yes | CN & MN - see state-specific FN | No | Orthodontia not covered | All services except emergency care and palliative treatment | Fee for service |
| South Carolina | Yes | CN | $3/visit | Limited to trauma care and emergency treatment for relief of pain and infection | Fee for service | |
| South Dakota | Yes | CN | $1/service unrelated to dentures | Fee for service, or percentage of charge for unlisted services | ||
| Tennessee | Yes | A & B - See state-specific FN | B1 - $15/visit, B2 - $25/visit | Limited to trauma care and emergency treatment for relief of pain and infection | ||
| Texas | Yes | CN & MN | No | Specified surgical procedures | Fee for service | |
| Utah | Yes | A, B & C - See state-specific FN | C - 10% of payment | A - limited to x-rays, fillings, extractions and root canals, B- non-pregnant adults limited to trauma care and emergency treatment for relief of pain and infection, C - limited to diagnostic and preventive services only with fillings and extractions | Specified services | Fee for service |
| Vermont | Yes | A & B - See state-specific FN | A - $3/day, B - $7/day | Exam and cleaning 2/year, endodontia limited to 3 teeth/lifetime, annual payment limit $475 for all services; crowns, bridges, orthodontia and periodontal not covered | Third molar surgery | Fee for service |
| U.S. Virgin Islands | Yes | CN | No | Services in public health facilities only unless referral made to outside dentist | Root canals and crowns | Fee for service |
| Virginia | Yes | CN & MN | No | Limited to trauma care and oral surgery | Fee for service | |
| Washington | Yes | CN & MN | No | Specified restorative services, including crowns and anterior root canals, not covered for adults | Specified services | Fee for service |
| West Virginia | Yes | CN & MN | No | Limited to trauma care including maxillofacial surgery and to emergency treatment for relief of pain and infection | Restorative services or item replacement | Fee for service |
| Wisconsin | Yes | CN & MN | $.50-$3/service depending on payment | Exam and cleaning 1/year, frequency of x-rays limited by type, orthodontia not covered | Specified services | Fee for service |
| Wyoming | Yes | CN | No | Limited to trauma care and emergency treatment for relief of pain and infection, 2 visits/year | Fee for service |
2003
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 51 No - 5 | Yes - 19 No - 32 | ||||
| Alabama | No | NA | ||||
| Alaska | Yes | CN | No | Limited to emergency treatment for relief of pain and infection | Fee for service | |
| American Samoa | Yes | See territory-specific FN | No | |||
| Arizona | Yes | CN & MN | No | Limited to emergency treatment for relief of pain and infection | Fee for service | |
| Arkansas | No | NA | ||||
| California | Yes | CN & MN | $1/visit | Specified services including periodontal, crowns and root canals, pre-denture services, services for nursing facility residents | Fee for service | |
| Colorado | No | NA | ||||
| Connecticut | Yes | CN & MN | No | Periodontal and fixed bridges not covered, frequency of x-rays limited by type | Specified services | Fee for service |
| Delaware | No | NA | ||||
| District of Columbia | No | NA | ||||
| Florida | Yes | CN & MN | 5% of payment | Limited to emergency treatment for relief of pain and infection | Fee for service | |
| Georgia | Yes | CN & MN | No | Limited to emergency treatment for relief of pain and infection, $600/year limit | Specified services | Fee for service |
| Guam | Yes | CN | No | Limited to trauma care, treatment required due to medical conditions, and emergency treatment for relief of pain and infection | Fee for service | |
| Hawaii | Yes | CN & MN | No | Limited to emergency treatment for relief of pain, infection and bleeding | Limited to emergency treatment for relief of pain, infection and bleeding | Fee for service |
| Idaho | Yes | CN | No | Limited to trauma care and emergency treatment for relief of pain and infection | Fee for service | |
| Illinois | Yes | CN & MN | No | Periodontia, posterior root canals and preventive services including exams and cleanings not covered; coverage limited to exams and x-rays necessary to assess oral health, to diagnose oral problems and to develop a treatment plan | Specified services | Fee for service through contracted intermediary |
| Indiana | Yes | CN | No | Exam and cleaning 1/year (2/year for nursing facility residents), frequency of x-rays limited by type, periodontia limited, second opinions required for specified procedures | Specified services including non-emergency inpatient procedures and oral surgery | Fee for service |
| Iowa | Yes | CN & MN | $3/day | Exam and cleaning 2/year, frequency of x-rays vary by type, orthodontia and periodontia not covered, endodontia limited to root canals for anterior teeth with crowns if necessary | Specified services including periodontal | Reasonable charge with limits |
| Kansas | Yes | CN & MN | $3/date of service | Limited to emergency treatment for relief of pain and infection | Specified services | Fee for service |
| Kentucky | Yes | CN & MN | No | Exam and cleaning 1/year, frequency of x-rays limited by type, alveoplasty 1/quad/lifetime, coverage of gingevectomy limited by diagnosis | Specified services including periodontal scaling and root planing | Fee for service |
| Louisiana | Yes | CN & MN - See state-specific FN | No | Exams and x-rays only covered in conjunction with denture construction; pregnant women may also receive specified preventive, restorative and periodontal services | Specified services | Fee for service |
| Maine | Yes | CN & MN | No | Limited to trauma care, diagnostic procedures for acute conditions, and emergency treatment for relief of pain and infection | Oral cancer treatment | Fee for service |
| Maryland | Yes | CN & MN | No | Services for non-pregnant adults limited to trauma care and emergency treatment rendered in a hospital emergency department | Fee for service | |
| Massachusetts | Yes | CN & MN | No | Limited to emergency care services including x-rays, extractions and oral surgery | Specified services | Fee for service |
| Michigan | Yes | CN & MN | $3/visit | Fee for service | ||
| Minnesota | Yes | A & B - See state-specific FN | B1 - 50% of payment for restorative services - See state-specific FN | A - includes limited orthodontia coverage | Specified services | Fee for service |
| Mississippi | Yes | CN | $3/visit | Limited to trauma care and emergency treatment for relief of pain and infection, maximum annual payments for specified services | Specified services | Fee for service |
| Missouri | Yes | CN | $.50-$3/ service depending on payment | Exam and cleaning 2/year (3/year for nursing facility residents) | Specified services | Fee for service |
| Montana | Yes | CN & MN | $4/visit | Exam and cleaning 2/year,frequency of x-rays limited by type, bridges limited to anterior teeth and crowns to posterior teeth | Specified services including prosthetics and oral surgery | Fee for service |
| Nebraska | Yes | CN & MN | $3/specified services | Exam and cleaning 1/year | Specified services including periodontia, crowns and root canals | Fee for service |
| Nevada | Yes | CN | No | Limited to trauma care and emergency treatment for relief of pain and infection | Fee for service | |
| New Hampshire | Yes | CN & MN | No | Limited to trauma care and emergency treatment for relief of pain and infection | Specified services | Fee for service |
| New Jersey | Yes | CN & MN | No | Exam and cleaning 2/year, frequency of x-rays limited by type | Specified services | Fee for service |
| New Mexico | Yes | CN | B - $5/visit non-preventive services - see state-specific FN | 1 exam and cleaning/year, frequency of x-rays limited by type | Specified services | Fee for service |
| New York | Yes | CN & MN | No | 3 visits/year (limit applicable to dental clinics but not dental offices) | Specified services | Fee for service |
| North Carolina | Yes | CN & MN | $3/episode of treatment | Exam and cleaning 2/year, frequency of x-rays limited by type, root canals limited to anterior teeth, prefabricated crowns and pulpotomies limited to 6/day, pulp caps and recement inlays and crowns not covered | Specified services including periodontal and orthodontic services and maxillofacial surgery | Fee for service |
| North Dakota | Yes | CN & MN | $2/visit | Specified services | Fee for service | |
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | No | Specified services | ||
| Ohio | Yes | CN | No | Specified services | Fee for service | |
| Oklahoma | Yes | CN | No | Limited to emergency extractions and smoking cessation counseling | Fee for service | |
| Oregon | Yes | CN & MN | $3/visit except diagnostic tests and routine exam/cleaning | Fee for service | ||
| Pennsylvania | Yes | CN & MN | No | CN: exam and cleaning 2/year, MN: preventive care not covered and medically necessary services limited to those provided in a hospital or ambulatory surgery center setting, CN & MN: crowns limited to 1/5 years, services in outpatient hospital or ambulatory surgery center setting limited to $500/procedure unless fee screen higher, services in inpatient hospital setting limited to $1,000/procedure unless fee screen higher | Prosthetics, crowns, multiple or surgical extractions, periodontia and endodontia | Fee for service |
| Puerto Rico | Yes | CN & MN | No | Exam and cleaning 2/year, 1 comprehensive exam/year | Fee for service | |
| Rhode Island | Yes | CN & MN - see state-specific FN | No | Orthodontia not covered | All services except emergency care and palliative treatment | Fee for service |
| South Carolina | Yes | CN | No | Limited to trauma care and emergency treatment for relief of pain and infection | Fee for service | |
| South Dakota | Yes | CN | $1/service unrelated to dentures | Fee for service, or percentage of charge for unlisted services | ||
| Tennessee | Yes | A & B - See state-specific FN | B1 - $15/visit, B2 - $25/visit | Limited to trauma care and emergency treatment for relief of pain and infection | ||
| Texas | Yes | CN & MN | No | Specified surgical procedures | Fee for service | |
| Utah | Yes | A, B & C - See state specific FN | C - 10% of payment for services other than routine exam/cleaning | A - limited to x-rays, fillings, extractions and root canals, B- non-pregnant adults limited to trauma care and emergency treatment for relief of pain and infection, C - limited to diagnostic and preventive services only with fillings and extractions | Specified services | Fee for service |
| Vermont | Yes | A & B - See state-specific FN | A - $3/day, B - $7/day | Exam and cleaning 2/year, endodontia limited to 3 teeth/lifetime, annual payment limit $475 for all services; crowns, bridges, orthodontia and periodontal not covered | Third molar surgery | Fee for service |
| U.S. Virgin Islands | Yes | CN | No | Services in public health facilities only unless referral made to outside dentist | Root canals and crowns | Fee for service |
| Virginia | Yes | CN & MN | No | Limited to trauma care and oral surgery | Fee for service | |
| Washington | Yes | CN & MN | No | Limited to emergency treatment for relief of pain and infection, restoration of teeth and dental health maintenance | Specified services | Fee for service |
| West Virginia | Yes | CN & MN | No | Limited to trauma care including maxillofacial surgery and to emergency treatment for relief of pain and infection | Restorative services or item replacement | Fee for service |
| Wisconsin | Yes | CN & MN | $.50-$3/service depending on payment | Exam and cleaning 1/year, frequency of x-rays limited by type, orthodontia not covered | Specified services | Fee for service |
| Wyoming | Yes | CN | No | Limited to trauma care and emergency treatment for relief of pain and infection, 2 visits/year | Fee for service |