Dental

Members with Standard Medicaid benefits are eligible for almost all dental and denturist services when they are medically necessary. 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.

Adult members with Standard Medicaid Benefits will have an annual $1,125 dental treatment services cap; Covered Anesthesia, dentures, diagnostic, and preventative services do not count towards the annual cap. Periodic service limits apply. It is important to note that Children age 0-20 and Adults determined categorically eligible for Aged, Blind, and Disabled Medicaid are not subject to the $1,125 annual dental treatment limit.

Adult members are responsible to pay for non-covered dental services and any dental treatment services received above the annual $1,125 limit.

Non-covered Services

Noble metal crowns, bridges, and orthodontia 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

List of covered dental services

Members age 20 and under

Adults

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
  • Partial dentures may be replaced every 5 years.
  • Full dentures may be replaced every 10 years.
  • One lost pair of dentures in a person’s life time is covered. 

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

For a full provider search, please go to  https://mtdphhs-provider.optum.com/