Medicaid Benefits: Dentures
This data is presented as an interactive tool that allows users to: filter by timeframe/year, select specific data columns (distributions), filter by state or geography, and view the data as a table, map, or trend chart.
2018
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limits on Services | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 31 No - 15 NR - 5 | 2018 data limited to CN | Yes - 7 | Yes - 27 | 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 | No | 1 denture/5 years, 1 reline/year; limits may be modified if shown to be medically necessary. | - | - |
| Colorado | Yes | CN | No | Complete dentures are limited to one time every 7 years, includes 6 months of relines. Requires PAR | - | - |
| Connecticut | Yes | CN | No | Full or partial dentures must have prior authorization. | - | - |
| Delaware | No | - | - | |||
| District of Columbia | Yes | CN | No | Requires a UR review prior to service; Some replacements require PA | - | - |
| Florida | Yes | CN | No | Prosthodontic Services- One upper, lower, or complete set of full or removable partial dentures per recipient per lifetime. One reline, per denture, per 366 days, per recipient. One all-acrylic interim partial (flipper) for the anterior teeth, per recipient. | - | - |
| Georgia | Yes | CN | $3 copay | Medical necessity. | - | - |
| Hawaii | No | - | - | |||
| Idaho | Yes | CN | No | 1 full upper and/or lower partial or full denture/5 to 7 years | - | - |
| Illinois | NR | NR | NR | NR | - | - |
| Indiana | Yes | CN | No | 1 full upper and/or lower denture or 1 partial denture/6 years. | - | - |
| Iowa | NR | NR | NR | NR | - | - |
| Kansas | No | - | - | |||
| Kentucky | No | - | - | |||
| Louisiana | Yes | CN | No | Limited to one complete or partial denture per arch in an eight year period | - | - |
| Maine | Yes | CN | No | subject to medical eligibility. 1 full upper and/or lower denture or 1 partial denture/5 years | - | - |
| Maryland | No | - | - | |||
| Massachusetts | Yes | CN | No | No | - | - |
| Michigan | Yes | CN | No | Dentures require PA; Limit of 1 replacement per 5 years per denture unless PA with sufficient documentation supports an exception | - | - |
| Minnesota | Yes | CN | No | Non-pregnant adults are limited to one set of dentures every six years. Pregnant women are limited to one set of dentures every three years. | - | - |
| Mississippi | No | - | - | |||
| Missouri | Yes | CN | No | Dentures must be prior authorized and considered "medically necessary" for Traditional Medicaid Adults. | - | - |
| Montana | No | - | - | |||
| Nebraska | Yes | CN | No | replacement of dentures is limited to once every five years one time within client's lifetime | - | - |
| Nevada | NR | NR | NR | NR | - | - |
| New Hampshire | No | - | - | |||
| New Jersey | Yes | CN | only Plan C and D. $5 per visit | 7.5 years unless demonstrates medical necessity | - | - |
| New Mexico | Yes | CN | No | No | - | - |
| New York | NR | NR | NR | NR | - | - |
| North Carolina | Yes | CN | $1 - $3 depending on the service | complete every 10 years; partials every 8 years | - | - |
| North Dakota | Yes | CN | No | 1 full upper and/or lower denture or 1 partial denture every 5 years if not repairable, 1 reline every 2 years | - | - |
| Ohio | Yes | CN | No | 1 per 8 years with PA | - | - |
| Oklahoma | Yes | CN | No | Covered only for adults in Nursing Homes | - | - |
| Oregon | Yes | CN | No | Full dentures are limited to 1 every 10 years and partial dentures are limited to 1 every 5 years, exceptions are made when dentally appropriate. | - | - |
| Pennsylvania | Yes | CN | Sliding scale based on the Medicaid fee for the service: $0.65 - $3.80 | Prior authorization required. 1 per lifetime (upper and lower arch). | - | - |
| Rhode Island | Yes | CN | No | No | - | - |
| South Carolina | NR | NR | NR | NR | - | - |
| South Dakota | Yes | CN | $3/denture or reline | Prior approval required. 1 full upper and/or lower denture or 1 partial denture or reline/5 years. | - | - |
| Tennessee | No | - | - | |||
| Texas | No | - | - | |||
| Utah | Yes | CN | No | Limited to once every 5 years and only for pregnant women or adults who are blind or disabled | - | - |
| Vermont | No | - | - | |||
| Virginia | No | - | - | |||
| Washington | Yes | CN | No | Requires PA | - | - |
| West Virginia | No | - | - | |||
| Wisconsin | Yes | CN | $0.50 - $3.00 per service | Prior authorization required | - | - |
| Wyoming | No | - | - |
2012
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 37 No - 19 | Yes - 8 No - 29 | ||||
| Alabama | No | |||||
| Alaska | Yes | CN | Dentures covered up to $2,300 in one year with no enhanced dental benefit the following year | Yes | Fee for service | |
| American Samoa | Yes | See territory-specific FN | Provided without limits based on medical necessity | |||
| Arizona | No | |||||
| Arkansas | Yes | CN & MN | 1 upper and lower denture/lifetime, 1 reline/3 years, 3 adjustments/lifetime; dentures excluded from $500 annual dental benefit cap | Yes | Fee for service, denture must be obtained from state-contracted denture manufacturer | |
| California | Yes | CN & MN | 1 denture/5 years, 1 reline/year, coverage limited to pregnant or institutionalized adults | Yes | Fee for service | |
| Colorado | No | |||||
| Connecticut | Yes | CN & MN | 1 full upper and/or lower denture or 1 partial denture/5 years, 1 reline/2 years, fixed bridgework not covered | Fee for service | ||
| Delaware | No | |||||
| District of Columbia | Yes | CN & MN | 1 full upper and/or lower denture or 1 partial/5 years, denture reline and rebase limited to 2/5 years, fixed prosthodontic (bridge) covered only if removable denture cannot be used and is cost effective, unilateral one-piece cast metal partial dentures not covered | Fee for service | ||
| Florida | Yes | CN & MN | 5% of payment/procedure | 1 full upper and/or lower partial or full denture/lifetime | Partial dentures and replacement full dentures | Fee for service |
| Georgia | No | |||||
| Guam | Yes | CN | Limited to post-trauma only | Fee for service | ||
| Hawaii | No | |||||
| Idaho | Yes | CN | 1 full upper and/or lower denture or 1 partial denture/5 to 7 years | Fee for service for Enhanced Plan, capitated payment for Basic Plan | ||
| Illinois | No | |||||
| Indiana | Yes | CN | 1 full upper and/or lower denture or 1 partial denture/6 years | Yes | Fee for service | |
| Iowa | Yes | CN & MN | 1 reline/year, 2 repairs/year | Partial dentures | Fee for service | |
| Kansas | No | |||||
| Kentucky | No | |||||
| Louisiana | Yes | CN | 1 full upper and/or lower denture/8 years, 1 reline on existing denture/7 years; partial lower denture only allowed to balance occlusion with full upper denture, repairs covered only if denture would then be fully serviceable | All services other than repairs | Fee for service | |
| Maine | Yes | CN and MN | 1 full upper and/or lower denture or 1 partial denture/5 years | Yes | Fee for service | |
| Maryland | No | |||||
| Massachusetts | yes | CN & MN | 1 full upper and/or lower denture or 1 partial/7 years, 1 upper and/or lower rebase or reline/3 years; dentures only covered for certain developmentally disabled adults | Yes | ||
| Michigan | Yes | CN & MN | $3/denture | 1 full upper and/or lower denture or 1 partial/5 years | Yes | Fee for service, Public Dental Clinics paid average commercial rate |
| Minnesota | Yes | A & B - See state-specific FN | Non-pregnant adults limited to 1 full upper and/or lower denture or 1 partial denture/6 years, dentures for pregnant women limited to 1 denture/3 years for each arch | Fee for service | ||
| Mississippi | No | |||||
| Missouri | Yes | CN | 5% of payment for denture and related services | 1 full upper and/or lower denture or 1 partial denture/lifetime, reline after 1 year, adult coverage limited to those who are pregnant, blind or residing in nursing facilities | Fee for service | |
| Montana | Yes | A & B - See state-specific FN | $5/denture-related visit | A - 1 full upper and/or lower denture/10 years, 1 partial denture/5 years, 1 replacement per lifetime (for lost denture) | Yes | Fee for service |
| Nebraska | Yes | CN & MN | $3/specified services | Replacement covered only if existing denture cannot be made wearable by reline or repair, $1,000 maximum benefit/year included with dental services | Replacement dentures | Fee for service |
| Nevada | Yes | CN | 1 full upper and/or lower denture or 1 partial upper and/or lower denture/5 years | Yes | Fee for service | |
| New Hampshire | No | |||||
| New Jersey | Yes | CN & MN | Dentures covered if specified occlusal criteria met, 1 full and/or partial dentures/7.5 years unless subsequent extractions make new denture necessary | Yes | Fee for service | |
| New Mexico | Yes | CN | 1 full upper and/or lower denture or 1 partial/5 years, A - this benefit is not covered | Yes | Fee for service | |
| New York | Yes | CN & MN | 1 full or partial denture/8 years | Yes | Fee for service | |
| North Carolina | Yes | CN & MN | $3/episode of treatment | 1 full upper and/or lower denture or 1 partial upper and/or lower denture/8 years; 1 upper and/or lower reline/5 years; implants, fixed bridges and cast partials not covered | Yes | Fee for service |
| North Dakota | Yes | CN & MN | 1 full upper and/or lower denture or 1 partial denture/5 years if not repairable, 1 reline/2 years | Fee for service | ||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | Limited to dentures delivered by government-operated facility | |||
| Ohio | Yes | CN | 1 full upper and/or lower denture or 1 partial denture/8 years if not repairable, 1 reline/4 years | Yes | Fee for service | |
| Oklahoma | No | |||||
| Oregon | Yes | A - See state-specific FN | A - $3/visit | Except for pregnant women, adult coverage is limited to only the recently edentulous; full dentures covered once/lifetime; partial dentures covered once/10 years | Fee for service, using a percentage of commercial rates | |
| Pennsylvania | Yes | CN | 1 full upper and/or lower denture or 1 partial (upper and/or lower) denture/lifetime; 1 complete denture (one/arch)/5 years for beneficiaries residing in a nursing facility or intermediate care facility | Yes | Fee for service | |
| Puerto Rico | No | |||||
| Rhode Island | Yes | See state-specific FN | Yes | Fee for service | ||
| South Carolina | No | |||||
| South Dakota | Yes | CN | $3/denture or reline | 1 full upper and/or lower denture or 1 partial denture or reline/5 years | Yes | Fee for service, or percentage of charge for unlisted services |
| Tennessee | No | |||||
| Texas | Yes | CN & MN | Adult coverage limited to ICF/MR residents | Specified services | Fee for service, cost based supplemental payment to government providers | |
| Utah | Yes | A - See state-specific FN | Adult coverage limited to pregnant women | Yes | Fee for service | |
| Vermont | No | |||||
| U.S. Virgin Islands | Yes | CN | Strict criteria of medical necessity must be met | Yes | Fee for service | |
| Virginia | No | |||||
| Washington | Yes | CN & MN | Covered for pregnant and post partum women and adults in institutions or participating in the state's HCBS programs; dentures also considered for adults if cancer treatment has destroyed teeth; 1 full upper and lower denture/5 years, 1 partial upper and 1 partial lower denture/5 years if cast metal (3 years if resin), 1 complete or partial rebase or reline/3 years but must be at least 6 months after seating | Yes | Fee for service | |
| West Virginia | No | |||||
| Wisconsin | Yes | CN & MN | Yes | Fee for service | ||
| Wyoming | Yes | CN | 1 full upper and lower denture or 1 partial denture/lifetime | Fee for service |
2010
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 38 No - 18 | Yes - 8 No - 30 | ||||
| Alabama | No | |||||
| Alaska | Yes | CN | Dentures covered up to $2.300 in one year with no denture benefit the following year | Yes | Fee for service | |
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | No | |||||
| Arkansas | Yes | CN & MN | 1 upper and lower denture/lifetime, 1 reline/3 years, 3 adjustments/lifetime; dentures excluded from $500 annual dental benefit cap | Yes | Fee for service, denture must be obtained from state-contracted denture manufacturer | |
| California | Yes | CN & MN | 1 denture/5 years, 1 reline/year, coverage limited to pregnant or institutionalized adults | Yes | Fee for service | |
| Colorado | No | |||||
| Connecticut | Yes | CN & MN | 1 full upper and/or lower denture or 1 partial denture/5 years, 1 reline/2 years, fixed bridgework not covered | Fee for service | ||
| Delaware | No | |||||
| District of Columbia | Yes | |||||
| Florida | Yes | CN & MN | 5% of payment for dentures and specified related services | 1 full upper and/or lower partial or full denture/lifetime | Partial dentures and replacement full dentures | Fee for service |
| Georgia | No | |||||
| Guam | Yes | CN | Limited to post-trauma only | Fee for service | ||
| Hawaii | No | |||||
| Idaho | Yes | CN | 1 full upper and/or lower denture or 1 partial denture/5 to 7 years | Fee for service for Enhanced Plan, capitated payment for Basic Plan | ||
| Illinois | Yes | CN & MN | 1 full upper and/or lower denture/5 years, partial dentures not covered but may be adjusted | Yes | Fee for service through contracted intermediary | |
| Indiana | Yes | CN | $600 maximum benefit/year included with dental services | Yes | Fee for service | |
| Iowa | Yes | CN & MN | 1 reline/year, 2 repairs/year | Fixed partial dentures, posterior partial dentures | Fee for service | |
| Kansas | No | |||||
| Kentucky | No | |||||
| Louisiana | Yes | CN & MN - See state-specific FN | 1 full upper and lower denture and 1 reline/7years, or 2 relines on existing denture/7 years; partial lower denture only allowed to balance occlusion with full upper denture, repairs covered only if denture would then be fully serviceable | All services other than repairs | Fee for service | |
| Maine | Yes | CN and MN | 1 full upper and/or lower denture or 1 partial denture/5 years | Yes | Fee for service | |
| Maryland | No | |||||
| Massachusetts | yes | CN & MN | 1 full upper and/or lower denture or 1 partial/7 years, 1 upper and/or lower rebase or reline/3 years; dentures only covered for certain developmentally disabled adults | Yes | ||
| Michigan | Yes | CN & MN | $3/denture | 1 full upper and/or lower denture or 1 partial/5 years | Yes | Fee for service, Public Dental Clinics paid average commercial rate |
| Minnesota | Yes | A & B - See state-specific FN | Non-pregnant adults limited to 1 full upper and/or lower denture or 1 partial denture/6 years, dentures for pregnant women limited to 1 denture/3 years for each arch | Fee for service | ||
| Mississippi | No | |||||
| Missouri | Yes | CN | 5% of payment for denture and related services | 1 full upper and/or lower denture or 1 partial denture/lifetime, reline after 1 year, adult coverage limited to those who are pregnant, blind or residing in nursing facilities | Yes | Fee for service |
| Montana | Yes | A & B - See state-specific FN | $5/denture-related visit | A - 1 full upper and/or lower denture/10 years, 1 partial denture/5 years, 1 replacement per lifetime (for lost denture) | Yes | Fee for service |
| Nebraska | Yes | CN & MN | $3/specified services | Replacement covered only if existing denture cannot be made wearable by reline or repair, $1,000 maximum benefit/year included with dental services | Replacement dentures | Fee for service |
| Nevada | Yes | CN | 1 full upper and/or lower denture or 1 partial upper and/or lower denture/5 years | Yes | Fee for service | |
| New Hampshire | No | |||||
| New Jersey | Yes | CN & MN | Dentures covered if specified occlusal criteria met, 1 full and/or partial dentures/7.5 years unless subsequent extractions make new denture necessary | Yes | Fee for service | |
| New Mexico | Yes | CN | 1 full upper and/or lower denture or 1 partial/5 years, A - this benefit is not covered | Yes | Fee for service | |
| New York | Yes | CN & MN | 1 full or partial denture/4 years | Yes | Fee for service | |
| North Carolina | Yes | CN & MN | $3/episode of treatment | 1 full upper and/or lower denture or 1 partial upper and/or lower denture/10 years, 1 upper and/or lower reline/5 years | Yes | Fee for service |
| North Dakota | Yes | CN & MN | 1 full upper and/or lower denture or 1 partial denture/5 years if not repairable, 1 reline/2 years | Fee for service | ||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | Limited to dentures delivered by government-operated facility | |||
| Ohio | Yes | CN | 1 full upper and/or lower denture or 1 partial denture/8 years if not repairable, 1 reline/4 years | Yes | Fee for service | |
| Oklahoma | No | |||||
| Oregon | Yes | A - See state-specific FN | A - $3/visit | Except for pregnant women, adult coverage is limited to only the recently edentulous; full dentures covered once/lifetime; partial dentures covered once/10 years | Fee for service, using a percentage of commercial rates | |
| Pennsylvania | Yes | CN | 1 full upper and/or lower denture or 1 partial denture/5 years | Yes | Fee for service | |
| Puerto Rico | No | |||||
| Rhode Island | Yes | See state-specific FN | Yes | Fee for service | ||
| South Carolina | No | |||||
| South Dakota | Yes | CN | $3/denture or reline | 1 full upper and/or lower denture or 1 partial denture or reline/5 years | Yes | Fee for service, or percentage of charge for unlisted services |
| Tennessee | No | |||||
| Texas | Yes | CN & MN | Adult coverage limited to ICF/MR residents | Specified services | Fee for service | |
| Utah | Yes | A - See state-specific FN | Adult coverage limited to pregnant women | Yes | Fee for service | |
| Vermont | No | |||||
| U.S. Virgin Islands | Yes | CN | Strict criteria of medical necessity must be met | Yes | Fee for service | |
| Virginia | No | |||||
| Washington | Yes | CN & MN | 2 full upper and lower dentures/lifetime, 1 partial upper and 1 partial lower denture/10 years, cast metal partial dentures and immediate dentures not covered | Yes | Fee for service | |
| West Virginia | No | |||||
| Wisconsin | Yes | CN & MN | Yes | Fee for service | ||
| Wyoming | Yes | CN | 1 denture/lifetime | Fee for service |
2008
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 39 No - 17 | Yes - 7 No - 32 | ||||
| Alabama | No | |||||
| Alaska | Yes | CN | Coverage of dentures is included in $1,150 annual limit and limited to 1 denture/5 years | Yes | Fee for service | |
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Must be medically necessary to alleviate a health problem | Yes | Fee for service | |
| Arkansas | No | |||||
| California | Yes | CN & MN | 1 denture/5 years, 1 reline/year | Yes | Fee for service | |
| Colorado | No | |||||
| Connecticut | Yes | CN & MN | 1 full upper and/or lower denture or 1 partial denture/5 years, 1 reline/2 years | Fee for service | ||
| Delaware | No | |||||
| District of Columbia | Yes | |||||
| Florida | Yes | CN & MN | 5% of payment for dentures and specified related services | 1 full upper and/or lower partial or full denture/lifetime | Partial dentures and replacement full dentures | Fee for service |
| Georgia | No | |||||
| Guam | Yes | CN | Limited to post-trauma only | Fee for service | ||
| Hawaii | Yes | CN & MN | 1 full or partial denture up to $1,000/year | Fee for service | ||
| Idaho | Yes | CN | 1 full upper and/or lower denture or 1 partial denture/5 years | Fee for service for Enhanced Plan, capitated payment for Basic Plan | ||
| Illinois | Yes | CN & MN | 1 full upper and/or lower denture/5 years, partial dentures not covered but may be adjusted | Yes | Fee for service through contracted intermediary | |
| Indiana | Yes | CN | $600 maximum benefit/year included with dental services | Yes | Fee for service | |
| Iowa | Yes | CN & MN | 1reline/year, 2 repairs/year | Fixed partial dentures, posterior partial dentures | Fee for service | |
| Kansas | No | |||||
| Kentucky | No | |||||
| Louisiana | Yes | CN & MN - See state-specific FN | 1 full upper and lower denture and 1 reline/7years, or 2 relines on existing denture/7 years, partial lower denture only allowed to balance occlusion with full upper denture, repairs covered only if denture would then be fully serviceable | All services other than repairs | Fee for service | |
| Maine | Yes | CN and MN | 1 full upper and/or lower denture or 1 partial denture/5 years | Yes | Fee for service | |
| Maryland | No | |||||
| Massachusetts | Yes | CN & MN | 1 full upper and/or lower denture or 1 partial/7 years, 1 upper and/or lower rebase or reline/3 years, immediate dentures not covered | Yes | Fee for service | |
| Michigan | Yes | CN & MN | $3/denture | 1 full upper and/or lower denture or 1 partial/5 years | Yes | Fee for service, Public Dental Clinics paid average commercial rate |
| Minnesota | Yes | A & B - See state-specific FN | 1 full upper and/or lower denture or 1 partial denture/3 years | Fee for service | ||
| Mississippi | No | |||||
| Missouri | Yes | CN | 5% of payment for denture and related services | 1 full upper and/or lower denture or 1 partial denture/lifetime, reline after 1 year, adult coverage limited to those who are pregnant, blind or residing in nursing facilities | Yes | Fee for service |
| Montana | Yes | A & B - See state-specific FN | $5/denture-related visit | A - 1 full upper and/or lower denture or 1 partial denture/10 years, 1 partial denture/5 years, 1 replacement per lifetime (for lost denture) B - Limited to services essential for employment | Yes | Fee for service |
| Nebraska | Yes | CN & MN | $3/specified services | Replacement covered only if existing denture cannot be made wearable by reline or repair, $1,000 maximum benefit/year included with dental services | Replacement dentures | Fee for service |
| Nevada | Yes | CN | 1 full upper and/or lower denture or 1 partial upper and/or lower denture/5 years | Yes | Fee for service | |
| New Hampshire | No | |||||
| New Jersey | Yes | CN & MN | Dentures covered if specified occlusal criteria met, 1 full and/or partial dentures/7.5 years unless subsequent extractions make new denture necessary | Yes | Fee for service | |
| New Mexico | Yes | CN | Yes | Fee for service | ||
| New York | Yes | CN & MN | Yes | Fee for service | ||
| North Carolina | Yes | CN & MN | $3/episode of treatment | 1 full upper and/or lower denture or 1 partial upper and/or lower denture/10 years, 1 upper and/or lower reline/5 years | Yes | Fee for service |
| North Dakota | Yes | CN & MN | 1 full upper and/or lower denture or 1 partial denture/5 years if not repairable, 1 reline/2 years | Fee for service | ||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | Limited to dentures delivered by government-operated facility | |||
| Ohio | Yes | CN | 1 full upper and/or lower denture or 1 partial denture/8 years if not repairable, 1 reline/4 years | Yes | Fee for service | |
| Oklahoma | No | |||||
| Oregon | Yes | A - See state-specific FN | Fee for service | |||
| Pennsylvania | Yes | CN | 1 full upper and/or lower denture or 1 partial denture/5 years | Yes | Fee for service | |
| Puerto Rico | No | |||||
| Rhode Island | Yes | CN & MN - see state-specific FN | Yes | Fee for service | ||
| South Carolina | No | |||||
| South Dakota | Yes | CN | $3/denture or reline | 1 full upper and/or lower denture or 1 partial denture or reline/5 years | Yes | Fee for service, or percentage of charge for unlisted services |
| Tennessee | No | |||||
| Texas | Yes | CN & MN | Adult coverage limited to ICF/MR residents | Specified services | Fee for service | |
| Utah | Yes | A - See state-specific FN | Adult coverage limited to pregnant women | Yes | Fee for service | |
| Vermont | No | |||||
| U.S. Virgin Islands | Yes | CN | Strict criteria of medical necessity must be met | Yes | Fee for service | |
| Virginia | No | |||||
| Washington | Yes | CN & MN | 1 full upper and 1 full lower denture/10 years, 1 partial upper and 1 partial lower denture/10 years | Yes | Fee for service | |
| West Virginia | No | |||||
| Wisconsin | Yes | CN & MN | Yes | Fee for service | ||
| Wyoming | Yes | CN | 1 denture/lifetime | Fee for service |
2006
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 36 No - 20 | Yes - 8 No - 28 | ||||
| Alabama | No | |||||
| Alaska | No | |||||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Must be medically necessary to alleviate a health problem | Yes | Fee for service | |
| Arkansas | No | |||||
| California | Yes | CN & MN | 1 denture/5 years, 1 reline/year | Yes | Fee for service | |
| Colorado | No | |||||
| Connecticut | Yes | CN & MN | 1 full upper and/or lower denture or 1 partial denture/5 years, 1 reline/2 years | Fee for service | ||
| Delaware | No | |||||
| District of Columbia | Yes | |||||
| Florida | Yes | CN & MN | 5% of payment for dentures and specified related services | 1 full upper and/or lower denture/lifetime | Partial dentures | Fee for service |
| Georgia | No | |||||
| Guam | Yes | CN | Limited to post-trauma only | Fee for service | ||
| Hawaii | No | |||||
| Idaho | Yes | CN | 1 full upper and/or lower denture or 1 partial denture/5 years | Fee for service | ||
| Illinois | Yes | CN & MN | 1 full upper and/or lower denture/5 years, partial dentures not covered but may be adjusted | Yes | Fee for service through contracted intermediary | |
| Indiana | Yes | CN | $600 maximum benefit/year included with dental services | Yes | Fee for service | |
| Iowa | Yes | CN & MN | 1reline/year, 2 repairs/year | Fixed partial dentures, posterior partial dentures | Fee for service | |
| Kansas | No | |||||
| Kentucky | No | |||||
| Louisiana | Yes | CN & MN - See state-specific FN | 1 full upper and lower denture and 1 reline/7years, or 2 relines on existing denture/7 years, partial denture only allowed to balance occlusion, repairs covered only if denture would then be fully serviceable | All services other than repairs | Fee for service | |
| Maine | Yes | CN and MN | 1 full upper and/or lower denture or 1 partial denture/5 years | Yes | Fee for service | |
| Maryland | No | |||||
| Massachusetts | Yes | CN & MN | 1 full upper and/or lower denture or 1 partial/7 years, 1 upper and/or lower rebase or reline/3 years, immediate dentures not covered | Yes | Fee for service | |
| Michigan | Yes | CN & MN | $3/denture | 1 full upper and/or lower denture or 1 partial/5 years | Yes | 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 | 1 full upper and/or lower denture or 1 partial denture/3 years | Fee for service | |
| Mississippi | No | |||||
| Missouri | Yes | CN | 5% of payment for denture and related services | 1 full upper and/or lower denture or 1 partial denture/lifetime, reline after 1 year, adult coverage limited to those who are pregnant, blind or residing in nursing facilities | Yes | Fee for service |
| Montana | Yes | A & B - See state-specific FN | $5/denture-related visit | A - 1 full upper and/or lower denture or 1 partial denture/10 years, 1 partial denture/5 years, 1 replacement per lifetime (for lost denture) B - Limited to services essential for employment | Yes | Fee for service |
| Nebraska | Yes | CN & MN | $3/specified services | Replacement covered only if existing denture cannot be made wearable by reline or repair | Replacement dentures | Fee for service |
| Nevada | Yes | CN | 1 full upper and/or lower denture or 1 partial upper and/or lower denture/5 years | Yes | Fee for service | |
| New Hampshire | No | |||||
| New Jersey | Yes | CN & MN | Dentures covered if specified occlusal criteria met, 1 full upper and/or lower denture/7.5 years | Yes | Fee for service | |
| New Mexico | Yes | CN | Yes | Fee for service | ||
| New York | Yes | CN & MN | Yes | Fee for service | ||
| North Carolina | Yes | CN & MN | $3/episode of treatment | 1 full upper and/or lower denture or 1 partial upper and/or lower denture/10 years, 1 upper and/or lower reline/5 years | Yes | Fee for service |
| North Dakota | Yes | CN & MN | 1 full upper and/or lower denture or 1 partial denture/5 years if not repairable, 1 reline/2 years | Fee for service | ||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | Limited to dentures delivered by government-operated facility | |||
| Ohio | Yes | CN | 1 full upper and/or lower denture or 1 partial denture/8 years if not repairable, 1 reline/4 years | Yes | Fee for service | |
| Oklahoma | No | |||||
| Oregon | Yes | A - See state-specific FN | Fee for service | |||
| Pennsylvania | Yes | CN | 1 full upper and/or lower denture or 1 partial denture/5 years | Yes | Fee for service | |
| Puerto Rico | No | |||||
| Rhode Island | Yes | CN & MN - see state-specific FN | Yes | Fee for service | ||
| South Carolina | No | |||||
| South Dakota | Yes | CN | $3/denture or reline | 1 full upper and/or lower denture or 1 partial denture or reline/5 years | Yes | Fee for service, or percentage of charge for unlisted services |
| Tennessee | No | |||||
| Texas | Yes | CN & MN | Adult coverage limited to ICF/MR residents | Yes | Fee for service | |
| Utah | Yes | A - See state-specific FN | Adult coverage limited to pregnant women | Yes | Fee for service | |
| Vermont | No | |||||
| U.S. Virgin Islands | Yes | CN | Strict criteria of medical necessity must be met | Yes | Fee for service | |
| Virginia | No | |||||
| Washington | Yes | CN & MN | 1 full upper and 1 full lower denture/10 years, 1 partial upper and 1 partial lower denture/10 years | Yes | Fee for service | |
| West Virginia | No | |||||
| Wisconsin | Yes | CN & MN | Yes | Fee for service | ||
| Wyoming | No |
2004
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 34 No - 22 | Yes - 7 No - 27 | ||||
| Alabama | No | |||||
| Alaska | No | |||||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Yes | Fee for service | ||
| Arkansas | No | |||||
| California | Yes | CN & MN | 1 denture/5 years, 1 reline/year | Yes | Fee for service | |
| Colorado | No | |||||
| Connecticut | Yes | CN & MN | 1 full upper and/or lower denture or 1 partial denture/5 years, 1 reline/2 years | Fee for service | ||
| Delaware | No | |||||
| District of Columbia | No | |||||
| Florida | Yes | CN & MN | 5% of payment for dentures and specified related services | 1 full upper and/or lower denture/lifetime, partial dentures not covered | Yes | Fee for service |
| Georgia | No | |||||
| Guam | Yes | CN | Limited to post-trauma only | Fee for service | ||
| Hawaii | No | |||||
| Idaho | Yes | CN | 1 full upper and/or lower denture or 1 partial denture/5 years | Fee for service | ||
| Illinois | Yes | CN & MN | 1 full upper and/or lower denture/5 years, partial dentures not covered but may be adjusted | Yes | Fee for service through contracted intermediary | |
| Indiana | Yes | CN | $600 maximum benefit/year included with dental services | Yes | Fee for service | |
| Iowa | Yes | CN & MN | 1 reline/year, 2 repairs/year | Fixed partial dentures, posterior partial dentures | Fee for service | |
| Kansas | No | |||||
| Kentucky | No | |||||
| Louisiana | Yes | CN & MN - See state-specific FN | 1 full upper and lower denture and 1 reline/7years, or 2 relines on existing denture/7 years, partial denture only allowed to balance occlusion, repairs covered only if denture would then be fully serviceable | All services other than repairs | Fee for service | |
| Maine | Yes | CN and MN | 1 full upper and/or lower denture or 1 partial denture/5 years | Models and x-rays | Fee for service | |
| Maryland | No | |||||
| Massachusetts | Yes | CN & MN | Limited to beneficiaries that meet 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, 1 denture reline/3 years | Yes | Fee for service | |
| Michigan | No | |||||
| Minnesota | Yes | A & B - See state-specific FN | B1 - 50% of payment for restorative services - See state-specific FN | 1 full upper and/or lower denture or 1 partial denture/3 years | Fee for service | |
| Mississippi | No | |||||
| Missouri | Yes | CN | 5% of payment for denture and related services | 1 full upper and/or lower denture or 1 partial denture/lifetime, reline after 1 year | Yes | Fee for service |
| Montana | Yes | A & B - See state-specific FN | $5/denture-related visit | A - 1 full upper and/or lower denture or 1 partial denture/10 years, 1 partial denture/5 years, 1 replacement per lifetime (for lost denture) B - Limited to services essential for employment | Yes | Fee for service |
| Nebraska | Yes | CN & MN | $3/specified services | Replacement covered only if existing denture cannot be made wearable by reline or repair | Replacement dentures | Fee for service |
| Nevada | Yes | CN | 1 full upper and/or lower denture or 1 partial upper and/or lower denture/5 years | Yes | Fee for service | |
| New Hampshire | No | |||||
| New Jersey | Yes | CN & MN | Dentures covered if specified occlusal criteria met, 1 full upper and/or lower denture/7.5 years | Yes | Fee for service | |
| New Mexico | Yes | CN | Yes | Fee for service | ||
| New York | Yes | CN & MN | Yes | Fee for service | ||
| North Carolina | Yes | CN & MN | $3/episode of treatment | 1 full upper and/or lower denture or 1 partial upper and/or lower denture/10 years, 1 upper and/or lower reline/5 years | Yes | Fee for service |
| North Dakota | Yes | CN & MN | 1 full upper and/or lower denture or 1 partial denture/5 years if not repairable, 1 reline/2 years | Fee for service | ||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | Limited to dentures delivered by government-operated facility | |||
| Ohio | Yes | CN | Yes | Fee for service | ||
| Oklahoma | No | |||||
| Oregon | Yes | A - See state-specific FN | Fee for service | |||
| Pennsylvania | Yes | CN & MN | 1 full upper and/or lower denture or 1 partial denture/5 years | Yes | Fee for service | |
| Puerto Rico | No | |||||
| Rhode Island | Yes | CN & MN - see state-specific FN | Yes | Fee for service | ||
| South Carolina | No | |||||
| South Dakota | Yes | CN | $3/denture or reline | 1 full upper and/or lower denture or 1 partial denture or reline/5 years | Yes | Fee for service, or percentage of charge for unlisted services |
| Tennessee | No | |||||
| Texas | Yes | CN & MN | Adult coverage limited to ICF/MR residents | Yes | Fee for service | |
| Utah | Yes | A - See state-specific FN | Adult coverage limited to pregnant women | Yes | Fee for service | |
| Vermont | No | |||||
| U.S. Virgin Islands | Yes | CN | Strict criteria of medical necessity must be met | Yes | Fee for service | |
| Virginia | No | |||||
| Washington | Yes | CN & MN | 1 full upper and 1 full lower denture/10 years, 1 partial upper and 1 partial lower denture/10 years | Yes | Fee for service | |
| West Virginia | No | |||||
| Wisconsin | Yes | CN & MN | Yes | Fee for service | ||
| Wyoming | No |
2003
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 34 No - 22 | Yes - 7 No - 27 | ||||
| Alabama | No | |||||
| Alaska | No | |||||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Yes | Fee for service | ||
| Arkansas | No | |||||
| California | Yes | CN & MN | 1 denture/5 years, 1 reline/year | Yes | Fee for service | |
| Colorado | No | |||||
| Connecticut | Yes | CN & MN | 1 full upper and/or lower denture or 1 partial denture/5 years, 1 reline/2 years | Fee for service | ||
| Delaware | No | |||||
| District of Columbia | No | |||||
| Florida | No | |||||
| Georgia | No | |||||
| Guam | Yes | CN | Limited to post-trauma only | Fee for service | ||
| Hawaii | No | |||||
| Idaho | Yes | CN | 1 full upper and/or lower denture or 1 partial denture/5 years | Fee for service | ||
| Illinois | Yes | CN & MN | 1 full upper and/or lower denture/5 years, partial dentures not covered but may be adjusted | Yes | Fee for service through contracted intermediary | |
| Indiana | Yes | CN | Yes | Fee for service | ||
| Iowa | Yes | CN & MN | 1 reline/year, 2 repairs/year | Fixed partial dentures, posterior partial dentures | Fee for service | |
| Kansas | No | |||||
| Kentucky | No | |||||
| Louisiana | Yes | CN & MN - See state-specific FN | 1 full upper and lower denture and 1 reline/7years, or 2 relines on existing denture/7 years, partial denture only allowed to balance occlusion, repairs covered only if denture would then be fully serviceable | All services other than repairs | Fee for service | |
| Maine | Yes | CN and MN | 1 full upper and/or lower denture or 1 partial denture/5 years | Models and x-rays | Fee for service | |
| Maryland | No | |||||
| Massachusetts | Yes | CN & MN | Coverage limited to specific conditions and 1 denture reline/3 years | Yes | Fee for service | |
| Michigan | Yes | CN & MN | $3/denture | 1 full upper and/or lower denture or 1 partial denture/5 years | Yes | Fee for service |
| Minnesota | Yes | A & B - See state-specific FN | B1 - 50% of payment for restorative services - See state-specific FN | 1 full upper and/or lower denture or 1 partial denture/3 years | Fee for service | |
| Mississippi | No | |||||
| Missouri | Yes | CN | 5% of payment for denture and related services | 1 full upper and/or lower denture or 1 partial denture/3 years, reline after 1 year | Yes | Fee for service |
| Montana | Yes | CN & MN | $5/denture-related visit | 1 full upper and/or lower denture or 1 partial denture/10 years, 1 partial denture/5 years, 1 replacement per lifetime (for lost denture) | Yes | Fee for service |
| Nebraska | Yes | CN & MN | $3/specified services | Replacement covered only if existing denture cannot be made wearable by reline or repair | Replacement dentures | Fee for service |
| Nevada | Yes | CN | 1 full upper and/or lower denture or 1 partial upper and/or lower denture/5 years | Yes | Fee for service | |
| New Hampshire | No | |||||
| New Jersey | Yes | CN & MN | Dentures covered if specified occlusal criteria met, 1 full upper and/or lower denture/7.5 years | Yes | Fee for service | |
| New Mexico | Yes | CN | Yes | Fee for service | ||
| New York | Yes | CN & MN | Yes | Fee for service | ||
| North Carolina | Yes | CN & MN | $3/episode of treatment | 1 full upper and/or lower denture or 1 partial upper and/or lower denture/10 years, 1 upper and/or lower reline/5 years | Yes | Fee for service |
| North Dakota | Yes | CN & MN | 1 full upper and/or lower denture or 1 partial denture/5 years if not repairable, 1 reline/2 years | Fee for service | ||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | Limited to dentures delivered by government-operated facility | |||
| Ohio | Yes | CN | Yes | Fee for service | ||
| Oklahoma | No | |||||
| Oregon | Yes | CN & MN | Fee for service | |||
| Pennsylvania | Yes | CN & MN | 1 full upper and/or lower denture or 1 partial denture/5 years | Yes | Fee for service | |
| Puerto Rico | No | |||||
| Rhode Island | Yes | CN & MN - see state-specific FN | Yes | Fee for service | ||
| South Carolina | No | |||||
| South Dakota | Yes | CN | $3/denture or reline | 1 full upper and/or lower denture or 1 partial denture or reline/5 years | Yes | Fee for service, or percentage of charge for unlisted services |
| Tennessee | No | |||||
| Texas | Yes | CN & MN | Adult coverage limited to ICF/MR residents | Yes | Fee for service | |
| Utah | Yes | A - See state-specific FN | Adult coverage limited to pregnant women | Yes | Fee for service | |
| Vermont | No | |||||
| U.S. Virgin Islands | Yes | CN | Strict criteria of medical necessity must be met | Yes | Fee for service | |
| Virginia | No | |||||
| Washington | Yes | CN & MN | Yes | Fee for service | ||
| West Virginia | No | |||||
| Wisconsin | Yes | CN & MN | Yes | Fee for service | ||
| Wyoming | No |