Dental Estimates
Supports in the creation of dental estimates
All Clinical Staff
When paging for a rapid response, how many times do we repeat the announcement?
3 times
Patient arrives for a recall appointment. Provider request for an FMX. What is the R/DA required to document?
The amount and type of X-Rays taken that would be considered an FMX based on Medi-Cal guidelines
What frequency are Prophys covered for patient above the age of 18?
6 months for 18-20 yo
Annually for 21+ yo
At what age are permanent teeth crowns a covered benefit?
13 years or older
Covered or not: Patient is scheduled for #9 extraction and delivery of a resin partial denture on the same day
No, immediate partial dentures are not covered
This EPIC Tab directs you to the Estimate section
Treatment Plan
Where can you find a cheat sheet of codes?
Attached to the badge
This must be updated based on CRA for patients 6yo and under.
Care Gaps/ Health Maintenance
Dental Sealants are covered to what age
20 years of age
A patient would like to get veneers on tooth #8,9 due to discoloration. Would this be a covered benefit?
No. Aesthetic procedures are not covered through Medi-Cal
This type of denture is not a covered benefit within five years after a patient receives an immediate denture, and an immediate denture cannot be billed as this type of appliance.
Complete dentures
Before we create an estimate, what must be completed first?
1. Treatment Plan is named under the provider
Ex: Dr. Tian 08/19/2026 Treatment Plan
2. Tx is phased and approved by provider (okay to leave some Tx under Pending)
True or False: During a fire drill, you must grab all of your belongings and meet at the designated evacuation area
False. You must bring your patient along with you and meet at the designated area.
Chart notes must be completed ____ hrs/days after the encounter
48 hours or 2 days
Frequency and coverage of Periodontal Maintenance
A covered benefit for two years after last the SRP was completed at 3 or 4 month frequency
If a crown needs to be redone, how long after would it be acceptable to get it replaced?
After 5 years
Patient had complete dentures delivered in January 2026, patient has not been seen since March and would like an adjustment, is this a covered benefit?
Yes, patient can have 2 covered adjustments per year after 6 months
True or False: If there is only one treatment plan, we can click on "Create"
True
Only medical providers (MD, DO, NP, PA, CNM) and registered nurses are authorized to initiate this emergency response after assessing a patient
Code Blue
True or False: Since SDF is a minimally invasive procedure we do not need a consent form or document
False. We must always obtain consent and document on patients chart such as tooth #/surface
A covered benefit for patients age 13 years and older, once per quadrant every 24 months
Periodontal Scaling and Root Planning
Patient is requesting a gold crown instead of porcelain/ceramic crown. Will the patient's insurance cover?
No, high noble metal crowns are not a covered benefit. Patient would need to pay out of pocket.
Patient's qualify for Partial Dentures if:
five posterior permanent teeth are missing
all four first and second permanent molars are missing, or
the first and second permanent molars and second premolar are missing on the same side.
Upon finalizing dental estimates, what document must we check to confirm fees are correct?
Dental Master Fee Schedule
A patient was super excited for their dental cleaning and lost consciousness in the dental chair. What steps need to be taken?
1) Inform the provider
2) Assess the patient
3) Page Rapid Response
4) Clear Rapid response
5) Submit incident report
OB patient is scheduled for a new patient exam. What are some actions the team must completed relating to their pregnancy?
1. Update OB/GYN status if patient is not receiving prenatal care at CC+OLE
2. Pregnancy CDT code is entered: Z33.3 pregnancy state, gestational carrier or Z39.2 Postpartum State
How often are sealants per tooth covered?
once per tooth every 36 months
What type of radiograhic images must be taken before starting a crown?
Bitewing and PA
Relines are a benefit after how long following a non-immediate prosthesis (without extractions)
12 months/1 year
The No Surprise Act requires health centers to provide dental estimates within how many days prior to an appointment?
3 business day
A diabetic patient becomes confused, sweaty, shaky, and unable to follow instructions. They are still conscious. What is the immediate treatment?
Inform the provider.
Administer a rapid acting source of glucose orally, if they can safely swallow, and monitor their response.
A provider diagnoses a post/BU for a tooth that has an existing RCT, but does not meet the criteria for a covered crown. Will the post be covered?
No, a post/BU most be completed with a qualifying RCT or Crown.
What teeth are covered for sealants?
1st, 2nd & 3rd molars that occupy the 2nd molar position
During cementation of a crown, what type of xrays are taken?
Bitewings - Pre and Post Cementation
Laboratory Reline is not a covered benefit for this type of Denture
Maxillary/Mandibular Partial Denture
A patient returns for treatment after an estimate was already created, and additional procedures are added to the treatment plan.
What is create a new estimate
A patient becomes unresponsive during treatment. You determine they are not breathing and cannot find a pulse. What should the dental team do next?
1) Activate Rapid Response
2) Begin CPR immediately
3) Communicate events to the Medical Response Team
When requesting prophylaxis beyond standard frequency limits, providers must document at the prophy visit this to justify the additional service
Patient's Medical Necessity
SDF is covered until what age?
Under 7 years and older than 7 when non restorative caries are present
Under what cirscumstances would a bridge be covered?
Only when medical conditions, which preclude the use of a removable partial denture, include:
1. The epileptic patient where a removable partial denture could be injurious to their health during an uncontrolled seizure
2. the paraplegia patient who utilizes a mouth wand to function to any degree and where a mouth wand is inoperative because of missing natural teeth
3. patients with neurological disorders whose manual dexterity precludes proper care and maintenance of a removable partial denture.
Are interim partials and complete dentures covered
No, they are not a benefit