Colorado Medicaid Billing Reference
Encounter-Based Reimbursement
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
| D0190 | Dental Screening |
| 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 5-20
| D0190 | Dental Screening |
| D1206 | Topical 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 |
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.
Required Certification Training for Primary Care Providers
Oral Health Services for Children
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 SmilesForLifeOralHealth.org
- 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 SmilesForLifeOralHealth.org
- 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.