The following procedure codes are reimbursable for HealthCheck agencies submitting claims for services performed by dentists and dental hygienists. Dentists and dental hygienists are not required to be Medicaid-enrolled.
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Diagnostic Procedures |
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Procedure Code |
Description of Service |
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D0191 |
Assessment of a patient |
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Preventative Procedures |
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Procedure Code |
Description of Service |
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Dental Prophylaxis |
|
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D1110 |
Prophylaxis — adult |
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D1120 |
child |
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Topical Fluoride Treatment (Office Procedure) |
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D1206 |
Topical application of fluoride varnish |
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D1208 |
Topical application of fluoride |
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Other Preventative Services |
|
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D1351 |
Sealant — per tooth |
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Periodontics Procedures |
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Procedure Code |
Description of Service |
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D4341 |
Periodontal scaling and root planing — four or more teeth per quadrant |
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D4342 |
Periodontal scaling and root planing — one to three teeth, per quadrant |
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Dental Examinations |
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|
Procedure Code |
Description of Service |
|
D0120 |
Periodic oral evaluation |
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D0150 |
Comprehensive oral evaluation — new or established patient |