D0145 Oral evaluation, counseling with a primary caregiver < 3
$34.24
D1206 Topical Fluoride Varnish
$41.96
Z13.84 Screening for Dental Disorders (EPSDT ICD 10—Diagnosis codes)
Pair with Well Child Visit and submit on electronic claim 837P Document formal Caries Risk Assessment in patient chart Reimbursable twice per year; two additional per year for high caries risk children
Billing Ages 3-4
D0190 Dental Screening
$17.88
D1206 Topical Fluoride Varnish
$41.96
Z13.84 Screening for Dental Disorders (EPSDT ICD 10—Diagnosis codes)
Pair with Well Child Visit and submit on electronic claim 837P Document formal Caries Risk Assessment in patient chart Reimbursable twice per year; two additional per year for high caries risk children
Billing Ages 5-20
D0190 Dental Screening
$17.88
D1206 Topical Fluoride Varnish
$41.96
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
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.
