Oral Health Toolkit

Childhood cavities are preventable and treatable with early preventive measures and early detection and treatment. The American Academy of Pediatric Dentistry recommends that children visit a dentist at the time of the eruption of the first tooth, no later than 12 months of age, and then every 6 months thereafter. Regular dental checkups, including the application of fluoride varnish and dental sealants by a dentist are covered by Medicaid.

Oral health assessments are a required part of every primary care well-child visit for young children so that primary care providers can assist in identifying children who need dental care.  In addition to oral health assessments, the application of fluoride varnish on children under the age of 3 is a Medicaid covered dental service in a primary care setting. Check out the Medicaid Provider Transmittal to learn more about how you can bill for and received Medicaid payment for oral health services in a primary care setting.

Note on Billing for Fluoride Varnish. Since FY 2014, DC Medicaid primary care providers who have completed fluoride varnish training can bill the Fee-for-Service (FFS) Medicaid program and the Medicaid Managed Care Organizations (MCOs) for fluoride varnish application on a child under 3 (three) years of age.  Currently, DC Medicaid primary care providers who are enrolled and trained by DC HealthCheck can bill FFS and the MCOs for the application of fluoride varnish using CDT code D1206 or CPT code 99188. When this policy was implemented in 2014, CDT code D1206 was the only procedure code for fluoride varnish application and since then CPT 99188 code was added to the fee schedule. 

Effective March 1, 2018, DC Medicaid (FFS and the MCOs) will no longer reimburse primary care providers for fluoride varnish claims submitted using the CDT code D1206. Only fluoride varnish claims submitted by primary care providers using the CPT code 99188 will be processed and paid. All fluoride varnish claims received by primary care providers for visits that occurred before March 1, 2018 will be processed. However, any varnish claims received by primary care providers for a date service after March 1, 2018, will only be paid if the claim for fluoride varnish application is coded using the CPT code 99188.

Fluoride Varnish Training for Primary Care Providers

The application of fluoride varnish for children under 3 by a trained DC HealthCheck primary care provider is a reimbursable dental/oral health procedure. In order to receive Medicaid reimbursement, primary care providers must complete the fluoride varnish training offered through DC HealthCheck. You can take the fluoride varnish training today (note: you must be current with your HealthCheck training before you can access and take the fluoride varnish training)!

Oral Health Practice Tools

Are you ready to incorporate oral health assessments, oral hygiene counseling and fluoride varnish application as part of your well-child exams? The American Academy of Pediatrics has great tools and resources available to help you get started.  The DC Pediatric Oral Health Coalition provides free on-site technical assistance to primary care providers and their staff on how to integrate oral health into the patient flow. To request technical assistance, email [email protected].

Connecting Families to a Medicaid Dentist

The DC Medicaid Dental Benefits brochure highlights all the information families need to know about their dental benefits, including how to access dental services and how to find their dental home. Access the brochure, along with other resources, from our Outreach Materials page. We encourage all DC HealthCheck Providers to distribute this informational brochure to their Medicaid patients during a well-child exam. Additionally, primary care providers can help connect families to their primary dentist by calling the Dental Helpline at 1-866-758-6807.

Oral Health Resources

The National Maternal and Child Oral Health Resource Center provides free resources to health care providers on latest best practices in delivering oral health services to children. Browse for the latest evidence-based practices by topic area (e.g. pregnancy, special needs children), and download culturally appropriate oral health educational materials to share with the families you serve.