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Members under age 21 with Standard Medicaid benefits are eligible for almost all dental and denturist services when they are medically necessary. Members with standard Medicaid benefits that are 21 and older are limited to diagnostic, preventative, basic restorative and extraction services. Pregnant women who present a Presumptive Eligibility Notice of Decision are eligible for dental services, as well. For further details, please consult your member guide.

Beginning July 1, 2016, all adult members with Standard Medicaid Benefits will have an annual $1,125 dental treatment services cap; excluding covered diagnostic, preventative, and anesthesia services. Periodic service limits apply. It is important to note the following exclusions from the annual dental treatment services cap: Children age 0-20 and Adults determined categorically eligible for Aged, Blind, and Disabled Medicaid (current Medicaid, not HELP).

Non-covered Services

Crowns, bridges, and dentures are not covered for members 21 years of age and older - No-show appointments - Cosmetic dentistry - Splints/mouthguards (age 21 and over) - Qualified Medicare Beneficiary (QMB) - Dental Implants

Members age 20 and under


Dentures for adults

  • Can get dental exams and cleanings as often as necessary
  • Should visit a dentist by their first birthday, and then at least once every six months after the first tooth comes in
  • During a Well Child Checkup, doctors should do an oral exam, including the application of fluoride varnish if needed
  • Bridges and tooth-colored crowns are available
  • Dentures
  • Find a Children's (20 and under) Dental Provider
  • $1,125 annual cap for treatment services
  • Can have dental exams and cleanings every six months
  • Dentures are not covered for adults
  • Partial dentures are not covered for adults

Work with your dental provider to ensure your services are a covered benefit.