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Colorado Medicaid Billing Reference

Encounter-Based Reimbursement

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Billing Ages 0-2

D0145 Oral Evaluation, counseling with a primary caregiver <3
D1206 Topical Fluoride Varnish
Z13.84 Screening for Dental Disorders (ESPSDT ICD 10- Diagnosis codes)Pair with Well Child Visit and submit on electronic claim 837PDocument formal Caries Risk Assessment in patient chartReimbursable twice per year; two additional per year for high caries risk children

Billing Ages 3-4

D0190Dental Screening
D1206Topical Fluoride Varnish
Z13.84 Screening for Dental Disorders (ESPSDT ICD 10- Diagnosis codes)Pair with Well Child Visit and submit on electronic claim 837PDocument formal Caries Risk Assessment in patient chartReimbursable twice per year; two additional per year for high caries risk children

Billing Ages 5-20

D0190Dental Screening
D1206Topical Fluoride Varnish
Z13.84 Screening for Dental Disorders (EPSDT ICD 10—Diagnosis codes)Reimbursable a maximum three times, regardless of risk.Not required to pair with well child; submit on electronic claim 837P

Billing Ages 0-2

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Required Certification Training for Primary Care Providers

Oral Health Services for Children

Caries Risk Assessment

Documentation of risk using a Pediatric Oral Health Screening form must be part of the child member’s medical and/or dental record.

Ages 0-12 years

Complete Cavity Free at Three Training. Visit CoOralHealth.org for upcoming certification trainings or to request a training.

OR

  • Complete Smiles for Life national curriculum online
    • Complete Child Oral Health course and Caries Risk Assessment, Fluoride Varnish, and Counseling Course.

Ages 12-20 years

    • Complete Smiles for Life national curriculum online

        • Complete Adult Oral Health Course and Caries Risk Assessment, Fluoride Varnish, and Counseling Course.

    • Qualified Medical Personnel include Physicians (MDs), Osteopaths (DOs), Nurse Practitioners (NPs) and Physicians Assistants (PAs) with a focus on primary care, general practice, internal medicine or pediatrics and who have completed training.

    • Qualified Medical Personnel who complete this training must provide documentation of this training when requested.