Preventative Path
This service category includes routine things like exams, cleanings, and diagnostic x-rays.
What is Preventative care?
This intermediate category covers standard dental issues like basic extractions and surface fillings.
What is Basic care?
Extensive major procedures include implants, bridges, dentures, and this common porcelain tooth cap.
What is a Crown?
True or False: These non-essential procedures, like bleaching and veneers, are covered by the Medicaid state plans.
What is False?
True or False: If a Preventative code is a covered benefit, our Medicaid plans pay 100% of the fee schedule.
What is True?
True or False: Fillings and extractions are covered at 100% of the fee schedule if they are covered benefits.
What is True?
True or False: Our Medicaid/Medicare plans cover approved Major care at 100% of the contracted fee schedule.
What is True? (Commercial plans vary, but our plans cover approved covered benefits at 100%).
If a member wants cosmetic tooth bonding, who is responsible for paying the dentist?
Who is the Member?
While our plans cover these preventative codes at 100% of the fee schedule, CCRs must check this specific custom report to verify the exact allowed frequencies or age limits for the member's plan.
What is the Benefit Plan Detail Report?
This common root nerve procedure may or may not be included at the basic care level of coverage depending entirely on the specific market plan being reviewed.
What is a Root Canal?
To determine if an office or a specific doctor needs to submit a prior authorization before performing extensive major services like crowns or implants, an advocate must open this specific report.
What is the Provider Authorization Schedule Report?
This specific non-essential procedure involves applying a composite material to the tooth surface to improve appearance. It is a cosmetic service, meaning the member must pay out of pocket.
What is Cosmetic Tooth Bonding?