Agencies
Services
Provider Notice issued 06/26/14
D0120 - Periodic Oral Evaluation
D1110 - Cleaning
D4341 - Periodontal Scaling and Root Planing-4 or more teeth per quadrant (deep cleaning)
D4342 - Periodontal Scaling and Root Planing-1-3 teeth per quadrant (deep cleaning)
D4355 - Full Mouth Debridement (gross removal of plaque and calculus)
Update in Adult Dental Program Services
| To: | All Enrolled Medical Assistance Program Providers |
| Date: | June 26, 2014 |
| Re: | Update in Adult Dental Program Services |
This informational notice covers important changes to adult dental services in the Healthcare and Family Services (HFS) Dental Program. Adult dental services are being restored as a result of Public Act 98-0651. In addition, this notice provides billing instructions for services covered exclusively for pregnant women.
Effective July 1, 2014, adult dental benefits will be restored to the 2011 levels. For a list of 2011 covered services and rates, go to: DentaQuest Dental Office Reference Manual (pdf) (page 106). A new 2014 Dental Office Reference Manual with complete listing of benefits and limitations will be published soon and sent to all HFS-enrolled dental providers.
In addition to the dental benefits listed for all eligible adults, pregnant women (prior to the birth of their children) are eligible for the following five preventive dental services:
In order to receive coverage for these additional services, providers must write “Pregnant” in the Remarks Field (Box 35) of the 2006 ADA claim form.
For more information, please contact your DentaQuest provider representative:
Timika Nunley at 855-333-8997
Jennifer Straub at 855-451-8814 or
DentaQuest Provider Relations Hotline at 888-281-2076
Theresa A. Eagleson, Administrator
Division of Medical Programs