healthy teeth healthy body arkansas medicaid s dental care for adults
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1 healthy teeth healthy body arkansas medicaid s dental care for adults
2 eeping your teeth healthy can help your whole body stay well. If your mouth and teeth are clean, you might not get sick as much. That s why Arkansas Medicaid now pays for some kinds of dental care for adults.
3 Who can get Medicaid dental care for adults? All adults who are on regular Medicaid can get some dental care. You cannot get Medicaid dental care if: You are a Qualified Medicare Beneficiary (QMB). You are on Tuberculosis (TB) Medicaid. You are on Family Planning Medicaid. You are on BreastCare. When does Medicaid s dental care start? July 1, 2009 How do I find a dentist? Call a dentist and ask if they accept adult Medicaid, or visit or call (TDD ).
4 What will Medicaid pay for? Medicaid will pay up to $500 a year for most dental care from July 1 to June 30 of each year. ONE office visit ONE cleaning ONE set of X-rays ONE fluoride treatment (to help stop cavities) Some things Medicaid will pay for do not count toward your $500 limit. Extractions Payment to lab only for partial dentures (ONE per lifetime) Payment to lab only for complete dentures (ONE per lifetime) If your dentist says you need it, Medicaid will pay for: ONE set of complete dentures per lifetime Simple tooth pulling Fillings Surgical tooth pulling (Medicaid must approve it first) Your dentist may say you need other types of dental care. It is up to you to make sure that Medicaid covers it. The next pages of this booklet show you a complete list of what Medicaid will pay for. Save this list so you and your dentist can see what Medicaid will pay. Arkansas Medicaid Adult dental services PRIOR APPROVAL ADULT DESCRIPTION OF PROCEDURE REQUIRED? LIMITATION Periodic oral evaluation 1 per year Limited oral evaluation problem focused Intraoral periapical first film Intraoral periapical each additional film Bitewings two films 1 per year Panoramic film I every 5 years Prophylaxis adult 1 per year Topical application of fluoride (prophylaxis not included) Adult 1 per year Tobacco counseling for the control/prevention of oral disease Amalgam one surface, primary or permanent Amalgam two surfaces, primary or permanent Amalgam three surfaces, primary or permanent Amalgam four or more surfaces, primary or permanent Resin-based composite one surface, anterior Resin-based composite two surfaces, anterior Resin-based composite three surfaces, anterior Resin-based composite four or more surfaces or invloving incisal angle anterior Recement crown Prefabricated stainless steel crown permanent tooth Peridontal scaling and root planing four or more contiguous Full mouth debridement to enable comprehensive evaluation and diagnosis Periodontal maintenance *Counts toward $500 total yearly benefit limit, for the period July 1 June 30.
5 PRIOR APPROVAL ADULT DESCRIPTION OF PROCEDURE REQUIRED? LIMITATION Complete denture maxillary No 1 per lifetime Complete denture mandibular No 1 per lifetime Maxillary partial denture resin base (including any conventional) 1 per lifetime Mandibular partial denture resin base (including any conventional) 1 per lifetime Repair resin denture base Replace broken teeth per tooth Add tooth to existing partial denture Adjust complete denture maxillary 3 per lifetime Adjust complete denture mandibular 3 per lifetime Recement fixed partial denture Extraction, erupted tooth or exposed root (elevation and/or forceps removal) Surgical removal of erupted tooth requiring elevation of mucoperiostea Removal of impacted tooth soft tissue Removal of impacted tooth partially bony Removal of impacted tooth completely bony Removal of impacted tooth completely bony, with unusual surgical complications Alveoplasty in conjunction with extraction four or more teeth or tooth spaces, per quadrant Surgical removal of residual tooth roots (cutting procedure) Biopsy of oral tissue hard (bone, tooth) Biopsy of oral tissue soft (all others) No Removal of torus palatinus 1 per lifetime Removal of torus mandibularis 1 per lifetime Incision and drainage of abcess intraoral soft tissue Palliative (emergency) treatment of dental pain minor procedure Behavior management, by report reported in 15-minute increments (tobacco cessation) *Counts toward $500 total yearly benefit limit, for the period July 1 June 30. Payment to dentist counts toward $500 yearly limit; payment to lab for manufacture of dentures does not count.
6 For more information:
7 THIS MATERIAL WAS PREPARED BY THE ARKANSAS FOUNDATION FOR MEDICAL CARE INC. (AFMC) UNDER CONTRACT WITH THE ARKANSAS DEPARTMENT OF HUMAN SERVICES, DIVISION OF MEDICAL SERVICES. THE CONTENTS PRESENTED DO NOT NECESSARILY REFLECT ARKANSAS DHS POLICY. THE ARKANSAS DEPARTMENT OF HUMAN SERVICES IS IN COMPLIANCE WITH TITLES VI AND VII OF THE CIVIL RIGHTS ACT. MB2-MBD.BRO,3-9/11
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