Adult Dental Coverage - Wa
Adult Dental Coverage
This flyer provides an overview of dental services for all adults age 21 and older covered by Washington Apple Health (Medicaid).
Covered services
Diagnostic Procedures
Exams t Initial comprehensive exam ? once per client,
per provider or clinic t Periodic exam ? 1 every 6 months t Limited exam ? as needed
X-rays t Complete series (FMX) ? 1 every 3 years t 4 bitewings ? every 12 months t Panorex ? every 3 years (A panorex is a two-
dimensional dental x-ray that displays both the upper and lower jaws and teeth in the same film.) t Periapical ? as needed (a possible abscess is a common need)
Preventive Services t Prophylaxis (cleaning) ? 1 every 12 months t Fluoride application (varnish)
21 and older ? 1 every 12 months Residents of alternative living facility ?
3 every 12 months
Basic Restorative (fillings) t Composite or amalgam restorations - once per
tooth in a 2-year period
Dentures/Partials t Complete dentures ? covered, with prior authorization
required t Partial dentures, resin based (acrylic) ? covered, with
prior authorization required t Rebase and reline of dentures ? 1 in a 3-year period, at
least 6 months after original dentures inserted t Replacement of partials ? may be covered if existing
dentures are at least 3 years old
Oral Surgery t Simple extractions, surgical extractions, biopsies,
intraoral and extraoral incise, and drain t Nitrous oxide sedation covered.
As of May 1, 2014, oral and other sedation methods or general anesthesia is considered on a case-by-case basis when a client has a medical condition for which general anesthesia is medically necessary (for example, tremors, seizures, behavioral health conditions, and breathing difficulties). Prior authorization is required.
Services that are not covered
t Bridges t Implants t Crowns
Periodontal (gum disease) t Scaling and root planing ? every 2 years per
quadrant t Perio maintenance ? once every 12 months
Endodontic (root canal) t Anterior (front) teeth only ? upper and lower
DIVISION OF DEVELOPMENTAL DISABILITIES (DDD) For adults with this designation, all coverage is the same as "Covered services" above, along with the following additions: t Topical fluoride ? 3 times per year t Sealants ? covered for posterior teeth t Crowns ? stainless steel only, covered for posterior teeth
with supporting documentation
HCA administers Washington Apple Health (Medicaid)
HCA 22-811 (7/15)
For more information about your covered dental benefits, contact: Health Care Authority 1-800-562-3022
To find a provider that accepts Washington Apple Health, visit:
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